3 


1 
1 


Presented  by 
Howard  M.   McGillis,   D.   0. 


COLLEGE  OF  OSTEOPATHIC  PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


^TREATMENT  OF  DISEASES 

OF 

INFANCY 


AND 


CHILDHOOD,---7 


WITH   OVER 

Four  Hundred  Formulae  and  Prescriptions, 

As  Exemplified  in  the  Services  of 

DRS.  A.  JACOBI,  J.  LEWIS  SMITH,  ALONZO  CLARK.  AI-STIN  FLINT.  W.  A.  HAM- 
MOND, A.    L.    LOOMIS,  W.  H.  THOMSON,  J.  H.  RIPLEY,  T.  GAILLARD 
THOMAS,  J.  .R.  LEANING,   F.  DELAFIELD,   L.  A.  SAYRE,  C.   R. 
AGNEW,  L.  DUNCAN  BULKLEY,  BEVERLY  ROBINSON,  R. 
W.  TAYLOR,  G.  H.  Fox,  F.  N.  OTIS,  A.  A.  SMITH, 
E.  C.  SEGUIN,  F.  A.  BURRALL,  E.  G. 
JANEWAY,  F.  H.  BOSWORTH,  A.  H. 
SMITH,  C.  ^.  BILLINGTON, 


G.  M. 


^EFFERTS, 


ETC.,  ETC., 

AND  IN  THE  HOSMT  \LS  OK  NEW  YORK  CITY. 


N, 

CHARLES  H.  GOODWIN,  M.  D. 


SECOND  EDITION,  RE  VISED. 


NEW  YORK : 
C.  H.  GOODWIN,  M.  D., 

245  WEST  53D  STREET. 
1883. 


\WS 


COPYRIGHT. 

BY  CHARLES  H.  GOODWIN,  M.D. 
A.  D.   1883. 


PREFACE. 


°)  In  this  volume  the  author  has  essayed  to  give  a 
thoroughly  practical,  and  at  the  same  time  concise, 

^  resume  of  the  treatment  of  the  various  diseases  incident 
7*  to  childhood.  His  apology  for  the  work  must  rest  upon 

^  the  very  large  number  of  requests  from  subscribers  to 
the  previous  volume  on  Treatment  of  Heart  and  Lung 
Diseases. 

From  the  numerous  investigations  that  have  recently 
been  made  in  infantile  diseases,  and  the  light  that  has 
been  thrown  'upon  them,  great  improvement  has 
developed  in  the  methods  of  treatment.  It  is  these 
recent  and  more  advanced  practical  therapeutical  views 
of  the  several  leading  medical  authorities  of  New  York 
City,  and  which  in  their  experiences  are  the  most 
approved  and  the  most  successful,  that  the  author  has 
endeavored  to  place  before  the  general  practitioner, 
fully  and  in  the  minutest  detail  and  yet  with  the  most 
careful  discrimination. 

Among  medical  publications  the  author  knows  of  none 
ilar  in  character  to  this,  and  it  is  earnestly  hoped 
P  that  the  work  will  prove  a  useful  one  to  the  profession. 


CONTENTS. 


PART  I. 

GENERAL  DISEASES. 

ANJEMIA 9 

Treatment  by  Dr.  A.  Jacobi,  (9);  by  Dr.  W.  A.  Hammond, 
(13);  by  Dr.  T.  Gaillard  Thomas,  (13);  by  Dr.  J.  Lewis 
Smith,  (14);  by  Dr.  A.  H.  Smith,  (17);  by  Dr.  Alonzo 
Clark,  (17);  by  Dr.  Beverly  Robinson,  (18). 

RACHITIS. 19 

Treatment  by  Dr.  A.  Jacobi,  (19);  by  Dr.  W.  H.  Thomson. 

(23). 

SCROFULOSIS 24 

Treatment  by  Dr.  J.  Lewis  Smith,  (24);  by  Dr.  A.  Jacobi, 
(26);  by  Dr.  F.  N.  Otis,  (26). 

ACUTE  RHEUMATISM, 27 

Treatment  by  Dr.  W.  H.  Draper,  (27);  at  New  Y9rk  Hos- 
pital, (30);  by  Dr.  A-  Jacobi,  (30);  by  Dr.  J.  H.  Ripley, 
(30);  by  Dr.  Alonzo  Clark,  (30);  by  Dr.  W.  H.  Thomson, 
(31);  by  Dr.  Austin  Flint,  (31);  at  Hart's  Island  Hospital, 
(33);  at  Bellevue  Hospital,  (33);  at  Roosevelt  Hospital,  (34); 
at  Charity  Hospital,  (34). 

SYPHILIS 35 

Treatment  by  Dr.  J.  Lewis  Smith,  (35);  by  Dr.  F.  N.  Otis, 
36);  at  Charity  Hospital,  (37);  by  Dr.  R.  W.  Taylor,  (37); 
by  Dr.  G-H.  Fox,  (38);  at  Bellevue  Hospital,  (40);  by  Dr. 
W.  H.  Draper,  (40);  at  New  York  Hospital,  (41);  at 
Roosevelt  Hospital,  (41). 

PART  II. 

DISEASES  OF  THE  AIR-PASSAGES. 

DIPHTHERIA 42 

Treatment  by  Dr.  J.  Lewis  Smith,  (42);  by  Dr.  A.  Jacobi, 
(45);  by  Dr.  C.  Billington,  (51);  by  Dr.  A.  A.  Smith,  (54); 
by  Dr.  F.  Delafield,  (54);  by  Dr.  Beverly  Robinson,  (55);  by 
Dr.  J.  H.  Ripley,  (56);  by  Dr.  Alonzo  Clark,  (56);  by  Dr. 
L.  Elsberg,  (56);  by  Dr.  J.  R.  Learning,  (56);  by  Dr.  E. 
C.Wendt,  (57);  the  Alcohol  or  "Brooklyn,"  treatment, 
(57). 


iv  CONTENTS. 

CORVZA 60 

Treatment  by  Dr.  J.  Lewis  Smith,  (60);  by  Dr.  A.  A. 
Smith,  (62);  by  Dr.  J.  R  Learning,  (63). 

TRUE  CROUP  (Acute  Croupous  Laryngitis) 63 

Treatment  by  Dr.  J.  H.  Ripley,  (63);  by  Dr.  J.  R.  Learn- 
ing, (67);  by  Dr.  J.  Lewis  Smith,  (68);  by  Dr.  F.  Delafield, 
(69);  by  Dr.  A.  Hadden,  (70);  by  Dr.  A.  L.  Loomis,  (73); 
by  Dr.  Austin  Flint,  (74). 

SPURIOUS  OR  CATARRHAL  CROUP  (Acute  Catarrhal  Laryngitis.)     74 
Treatment  by  Dr.  J.  Lewis  Smith,  (74);  by  Dr.  F.  Delafield, 
(75);  by  Dr.  A.  L.  Loomis,  (76). 

LARYNGISMUS  STRIDULUS  (Spasmodic  Croup)  78 

Treatment  by  Dr.  J.  Lewis  Smith,  (78);  by  Dr.  A.  I  .  Loomis, 
(79);  by  Dr.  W.  H.  Thomson,  (79);  by  Dr.  A.  A.  Smith, 
(79);  by  Dr.  F.  Delafield.  (80). 

HOOPING  COUGH 81 

Treatment  by  Dr.  J.  Lewis  Smith,  (81);  by  Dr.  A.  Jacobi, 
(82);  by  Dr.  J.  R.  Learning,  (82);  by  Dr.  H.  S.  Dessau,  (82); 
by  Dr.  A.  L.  Loomis,  (83);  at  Bellevue  Hospital,  (83);  at 
the  Infants'  Hospital,  (84). 

EPISTAXIS 84 

Treatment  by  Dr.  A.  Jacobi,  (84);  by  Dr.  G.  M.  Lefferts, 
(85);  by  Dr.  W.  H.  Draper.  (85);  by  Dr.  Alonzo  Clark,  (85). 


PART  III. 

DISEASES  OF  THE  DIGESTIVE  ORGANS. 

STOMATITIS 87 

Treatment  by  Dr.  J.  Lewis  Smith,  (87);  by  Dr.  J.  .H.  Ripley, 
(88);  at  the  Nursery  and  Child's  Hospital,  (89). 

TONSILLITIS 90 

Treatment  by  Dr.  A.  Jacobi,  (90);  by  Dr.  J.  R.  Learning, 
(91);  by  Dr.  F.  Delafield,  (91);  by  Dr.  F.  H.  Bosworth,  (93); 
by  Dr.  W.  H.  Draper,  (93);  at  New  York  Hospital,  (93); 
by  Dr.  F.  A.  Burrall,  (94);  by  Dr.  G.  M.  Lefferts,  (94);  by 
Dr.  Beverly  Robinson,  (97);  by  Dr.  F.  H.  Hamilton,  (97). 

PHARYNGITIS 98 

Treatment  by  Dr.  A.  Jacobi,  (98);  by  Dr.  A.  H.  Smith, 
(100);  by  Dr.  F.  H.  Bosworth,  (100);  by  Dr.  A.  A.  Smith, 
(ioi);  by  Dr.  F.  Delafield,  (101  ;  by  Dr.  G.  M.  Lefferts, 
(102). 

VOMITING — DYSPEPSIA.  ...         102 

Treatment  by  Dr.  J.  Lewis  Smith,  (102);  at  the  Infants' 
Hospital,  (103);  by  Dr.  A.  H.  Smith,  (103);  by  Dr.  A.  A. 
Smith,  (104);  by  Dr.  W.  A.  Hammond,  (105);  by  Dr.  F. 
Delafield,  (106). 


CONTENTS.  V 

GASTRITIS 106 

Treatment  by  Dr.  F.  Delafield,  (106). 
ENTERALGIA  (Colic) — ENTERITIS 108 

Treatment  by   Dr.    J.    W.   McLane,   (108);  by  Dr.  F.  A. 

Bunall,   (108);  by  Dr.  Austin  Flint,    (109);  by  Dr.  A.   A. 

Smith,  (109);  by  Dr.  F.  H.  Hamilton,  (log);  at  the  Infants' 

Hospital,  (no);  at  New  York    Hospital,  (no);  by  Dr.    F. 

Delaiield,  (ill). 
DIARRHOEA 112 

Treatment  by  Dr.  J.    Lewis  Smith,   (112);  by  Dr.    E.    G. 

Janeway,  (113);  by  Dr.  A.  A.  Smith,  (114);  by  Dr.  F.  Dela- 
field,   (115);    at   the   Infants'    Hospital,    (116);    at    Hart's 

Island  Hospital,  (116);   at  Bellevue  Hospital,  (117). 
INTESTINAL  CATARRH 118 

Treatment  by  Dr.  A.  Jacobi,  (118);  by  Dr.  J.  Lewis  Smith, 

(121);  by  Dr.  F.  Delafield,  (122);  by  Dr.  A.  A.  Smith,  (125); 

at  Bellevue  Hospital,  (126). 
DYSENTERY 126 

Treatment  by  Dr.  F.   Delafield,   (126);   by  Dr.   J.    Lewis 

Smith,  (128);  by  Dr.  G.    B.    Fowler,  (129);  by  Dr.    Alonzo 

Clark,  (129);  at  Bellevue  Hospital,  (130). 
CHOLERA  INFANTUM  (Spurious  Hydrocephalus) 130 

Treatment   by   Dr    J.  Lewis  Smith,   (130);  at  New  York 

Foundling  Asylum,  (131);  by  Dr.  F.  Delafield,  (133). 
CONSTIPATION 134 

Treatment  by  Dr.  A.  Jacobi,   (134);  by  Dr.   A.    A.   Smith, 

(137). 
WORMS 137 

Treatment  by  Dr.  J.  Lewis  Smith,  (137);  by  Dr.  A.  Jacobi, 

(138);  by  Dr.  Van  Giesen,  (139). 
INCONTINENCE  OF  URINE 140 

Treatment  at  Bellevue  Hospital,  (140). 
INFANTILE  LEUCORRHCEA 141 

Treatment  by  Dr.  T.  Gaillard  Thomas,  (141);  by  Dr.  J.  B. 

Hunter,  (142) ;  by  Dr.  V.  P.  Gibney,  (143) ;  by  Dr.  Beverly 

Robinson,  (143);  at  New  York  Hospital,  (143). 


PART  IV. 

DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 

CONVULSIONS 144 

Treatment  by  Dr.  J.  Lewis  Smith,  (144);  by  Dr.  A.  Jacobi, 
(146);  by  Dr.  A.  A.  Smith,  (147);  by  Dr.  E.  C.  Seguin,  (152). 


VI  CONTENTS. 

CHOREA 153 

Treatment  by  Dr.  J.  Lewis  Smith,  (153);  by  Dr.  A.  Jacobi, 
(154);  by  Dr.  W.  A.  Hammond,  (155);  by  Dr.  E.  C.  Seguin, 
(156);  by  Dr.  W.  H.  Thomson,  (157);  by  Dr.  E.  G.  Jane- 
way,  (157);  at  New  York  Hospital,  (158). 

EPILEPSY 158 

Treatment  by  Dr.  W.  A.  Hammond,  (I58):  by  Dr.  J. 
Lewis  Smith,  (163);  by  Dr.  E.  C.  Seguin,  (163). 

INFANTILE  PARALYSIS 167 

Treatment  by  Dr.  A.  Jacobi,  (167);  by  Dr.  F.  Delafield, 
(169);  by  Dr.  W.  A.  Hammond,  (169);  by  Dr.  E.  C. 
Seguin,  (170);  at  Bellevue  Hospital,  (173);  at  Charity  Hos- 
pital, (173). 

ACUTE  MENINGITIS 173 

Treatment  by  Dr.  F.  Delafield,  (173);  by  Dr.  E.  C.  Seguin, 
(175);  by  Dr.  W.  A.  Hammond,  (175). 

ACUTE  HYDROCEPHALUS  (Tubercular  Meningitis) 176 

Treatment  by  Dr.  F.  Delafield,  (176);  by  Dr.  J.  Lewis 
Smith,  (177). 

SPURIOUS  HYDROCEPHALUS — SEE  CHOLERA  INFANTUM. 

CHRONIC  HYDROCEPHALUS 178 

Treatment  by  Dr.  F.  Delafield,  (178);  by  Dr.  E.  C.  Seguin, 
(178). 

CEREBRO-SPINAL  MENINGITIS 179 

Treatment  by  Dr.  F.  Delafield,  (179);  by  Dr.  J.  Lewis 
Smith,  (181);  by  Dr.  F.  A.  Burrall,  (182);  by  Dr.  W.  H. 
Draper,  (183). 

SPINA  BIFIDA 184 

Treatment  by  Dr.  L.  A.  Sayre,  (184);  by  Dr.  A.  Jacobi,  (185); 
by  Dr.  H.  B.  Sands,  (185);  by  Lister,  (185). 


PART    V. 

FEVERS. 

TYPHOID  FEVER 186 

Treatment  by  Dr.  W.  H.  Draper,  (186);  by  Dr.  Beverly 
Robinson,  (192);  by  Dr.  F.  Delafield,  (193);  by  Dr.  W.  11. 
Thomson,  (194);  by  Dr.  A.  H.  Smith,  (195);  by  Dr.  Austin 
Flint,  (196) ;  at  Bellevue  Hospital,  (196) ;  by  Dr.  A.  L. 
Loomis,  (198). 

SCARLET  FEVER 202 

Treatment  by  Dr.  Alonzo  Clark,  (202);  by  Dr.  J.  Lewis 
Smith,  (204);  by  Dr.  A.  L.  Loomis,  (205);  by  Dr.  G.  M. 
Lefferts,  (207)  ;  by  Dr.  F.  A.  Burrall,  (207)  ;  by  Dr.  D. 


CONTENTS.  Vll 

Lewis,  (207);  by  Dr.  A.  Jacobi,  (209);  by  Dr.  J.  H.  Rip- 
ley,  (210). 
MEASLES 216 

Treatment  by   Dr.    Alonzo   Clark,    (216)  ;   by  Dr.   A.   L. 

Loomis,  (217). 
VARIOLA  (Small  Pox) 219 

Treatment  by  Dr.  J.  N.  McChesney,  (219);  by  Dr.  Alonzo 

Clark,  (225);  by  Dr.  A.   L.   Loomis,  (227);  by  Dr.  W.   H. 

Thomson,  (228). 
INTERMITTENT  FEVER 228 

Treatment  by  Dr.  Austin  Flint,  (228)  by  Dr.  Alonzo  Clark, 

(229);  by  Dr.   F.  A.   Burrall,  (230)  ;  by  Dr.  J.  C.   Peters, 

(231);  at  New  York  Hospital,  (231);  by  Dr.  A.  L.  Loomis, 

(232);  at   Bellevue  Hospital,  (234). 
TYPHUS  FEVER 235 

Treatment  by   Dr.    Austin   Flint,    (235) ;    by   Dr.    A.    L. 

Loomis,  (238). 
OTITIS  (Ear-Ache) 241 

Treatment  by  Dr.  O.  D.  Pomeroy,  (241);  by  Dr.  A.  Jacobi, 

(243);  by  Dr.  R.  F.  Weir,  (244);  by  Dr.  A.  A.  Smith,  (244); 

by  Dr.  Beverly  Robinson,  (244);  by  Dr.  C.  R.  Agnew,  (244); 

by  Dr.  S.  Sexton,  (245). 
OPHTHALMIA 248 

Treatment  by  Dr.  C.   R.  Agnew,  (248) ;  by  Dr.  J.   Lewis 

Smith,  (250). 


PART  VI. 

SKIN   DISEASES. 

ECZEMA 251 

Treatment  by  Dr.   L.   Duncan  Bulkley,  (251);    by  Dr.  A. 

Jacobi,  (258);  at  Bellevue  Hospital,  (259);    by  Dr.   G.   H. 

Fox,  (259);  by  Dr.  W.   H.    Draper,  (263);  by  Dr.   R.  W. 

Taylor,  (264);  at  New  York  Hospital,  (264). 
HERPES 265 

Treatment  by  Dr.  G.  H.  Fox,  (265);  by  Dr.  W.  H.  Draper, 

(266). 
ERYSIPELAS 267 

Treatment  by  Dr.  A.  Jacobi,  (267);  by  Dr.  V.   P.  Gibney, 

(268);  at  Bellevue  Hospital,  (268);  at  Presbyterian  Hospital, 

(268). 
ERYTHEMA 269 

Treatment  by  Dr.  L.  D.  Bulkley,  (269);  by  Dr.  G.  H.  Fox, 

(270). 


Vlll  CONTENTS. 

URTICARIA 270 

Treatment  by  Dr.  L.  D.  Bulkley,  (270);  by  Dr.  G.  H.  Fox, 
(271);  by  Dr.  A.  A.  Smith,  (271). 

SCABIES  (Itch) 272 

Treatment  by  Dr.  W.  H.  Draper,  (272);  by  Dr.  G.  H.  Fox, 
(273);  by  Dr.  L.  D.  Bulkley,  (273);  at  Bellevue  Hospital, 
(274). 

PHTHIRIASIS  (Lousiness) 274 

Treatment  by  Dr.  G.  H.  Fox,  (274). 

TINEA  FAVOSA  (Favus) 276 

Treatment  by  Dr.  L.  D.  Bulkley,  (276). 
TINEA  TONSURANS  (Ringworm) 278 

Treatment  by  Dr.  G.  H.  Fox,  (278);  at  Bellevue  Hospital, 

(278). 
ALOPECIA  AREATA  (Tinea  Decalvans) 279 

Treatment  by  Dr.  G.  H.  Fox,  (279). 
PSORIASIS 281 

Treatment  by  Dr.  G.  H.  Fox,  (281). 
PITYRIASIS 282 

Treatment  by  Dr.  G.  H.  Fox,  (282). 
PURPURA  H^EMORRHAGICA    (Morhus  Maculosus) 283 

Treatment  by  Dr.  A.  Jacobi,  (283). 


PART  I. 
GENERAL    DISEASES. 


ANAEMIA. 
i 


DR.  A.  JACOBI  believes  the  occurrence  of  anaemia 
%  in  infancy  and  childhood,  to  be  a  circumstance  of  vital 
'^importance.     He,  moreover,  directs  especial  atten- 
tion to  the  fact,  that  although  this  condition  is  so 
^  frequently  observed  and  so  dangerous,  and  one  which 
Bought  to  be  treated  of  by  the  best  of  practitioners 
^and  writers,  yet  there  is  no  text-book  in  which  a 
5\comprehensive  study  of  the  subject  can  be  found. 
In  all  cases,  he   advises   that  plenty  of  out-door 

exercise  be  taken,  and  if  necessary  this  should  be 
^  enforced.  Crowded  school-rooms,  and  excessive  les- 
t  sons,  should  be  particularly  avoided.  Regarding  the 
i  diet,  irregular  and  fast  eating  is  prohibited  as  bad 
x  habits.  For  infants,  he  directs  that,  in  the  main, 

solid  food  be  withheld.  Barley-water  and  cow's 
\  milk,  in  his  opinion,  will  make  far  better  muscle  than 
k  poor  mother's  milk.  Cow's  milk,  either  undiluted  or 


IO  ANAEMIA. 

diluted  with  water  only,  is  also  prohibited.  The 
same  restrictions  are  insisted  upon  regarding  con- 
densed milk.  In  fact,  DR.  JACOBI  advises  that  no 
milk  whatever  should  be  used,  without  the  addition 
of  some  gelatinous  or  farinaceous  decoction,  such  as 
barley-water,  etc.  ;  and  particularly  in  anaemia  beef- 
soup  should  be  added.  At  the  end  of  the  first  year 
solid  food  may  be  given,  and  such  articles  be  gradu- 
ally included  in  the  diet  as  physiology  and  experience 
permits. 

Regarding  the  use  of  remedial  agents,  he  finds  that 
although  iron  has  long  been  resorted  to  in  the  treat- 
ment of  anaemia  and  chlorosis,  yet  a  great  many 
children  recover  in  consequence  of  the  change  of 
diet,  together  with  rest  and  an  improved  general 
nutrition,  and  without  the  use  of  any  iron  what- 
ever. Besides,  he  frequently  meets  with  cases 
in  which  the  administration  of  iron  is  abso- 
lutely unavailing.  In  using  this  remedy,  how- 
ever, the  preparations  which,  in  his  experience, 
are  most  beneficial,  are  the  lactate,  the  tincture 
of  the  pomate,  the  pyrophosphate,  the  subcar- 
bonate,  and  the  tincture  of  the  chloride,  or  muri- 
ated  tincture.  They  should  not,  however,  be  given 
in  the  ^inflammatory  fevers,  although  they  may  be  in 
the  septic  type.  Where,  in  addition,  an  absorbent 
is  indicated,  as  in  slow  convalescence  after  inflam- 


ANEMIA.  1 1 

mations  resulting  in  exudation,  and  especially  In 
diseases  of  the  glands  and  lungs,  the  syrup  of  the 
iodide  is  used,  thus : 

I-fc.    Syrupi  ferri  iodid.  .         .  gtt.x. 

Aquae     .....  q.  s. 

M.  Sig.  Dose,  thrice  daily,  to  a  child  of  two  years. 
The  iodide,  he  advises,  meets  two  indications,  and, 
moreover,  the  iodine  is  set  free  in  the  stomach  and 
interferes  with  decomposition.     When  gastric  catarrh 
is  present  and  hinders  the  general  improvement  in 
progressive  anaemia,  or  during  slow  convalescence,  he 
finds  the  following  combination  especially  beneficial : 
$.    Ferri  subcarbon.       .         .  gr.  iv-viii. 

Bismuth,  subcarbon.        .         gr.  xii-xxiv. 
Sodii  bicarb.  .         .         gr.  xvi-xxx. 

M.    Sig.  This  amount  daily,  to  a  child  of  two  years. 

When  the  action  of  the  heart  is  lowered  and  the 
blood-pressure  diminished,  DR.  JACOBI  gives  the 
tincture  of  the  chloride  (being  a  vascular  irritant) 
with  greatest  service.  In  cases  of  anaemia  associated 
with  gastric  catarrh,  and  catarrh  of  the  upper  portion 
of  the  small  intestine,  he  considers  the  pyrophosphate 
the  more  desirable  preparation.  He  also  uses  the 
hypophosphites  and  the  phosphates  with  good,  results. 
In  chronic  anaemia  he  finds  they  are  all  valuable.  In 
these  chronic  cases,  also,  and  especially  where  there 


12  ANEMIA. 

is  a  peculiar  torpid  condition  of  the  stomach,  much 
benefit  is  frequently  derived  by  him  from  the  admin- 
istration of  arsenic,  in  minute  doses,  daily,  well 
diluted  with  water ;  he  gives  it  thus  : 

Ijfc.    Liq.  potass,  arsenit.     .         .         .    m.  i-ii. 

Aquae q.  s. 

M.    Sig.  Dose,  after  meals. 

Or,  he  often  prescribes  it  with  iron,  and  with  or 
without  stomachics.  By  this  means,  he  finds  that 
marked  results  obtain  from  improving  the  general 
nutrition,  and  this  is  particularly  so  in  cases  where 
there  is  also  nervous  trouble.  He  has  also  found 
strychnia  sulphate,  in  doses  of  gr.  -^  daily,  to  a  child 
of  two  years,  very  serviceable  as  an  adjuvant  to 
either  arsenic  or  iron,  its  use  being  continued  for  a 
long  period  of  time,  combined  with  proper  food.  In 
some  instances  phosphorus  is  employed  by  him  with 
much  benefit,  and  in  cases  associated  with  caries, 
etc.,  he  often  obtains  very  favorable  results.  The 
following  is  the  formula  for  the  tincture  of  phos- 
phorus used  at  BELLEVUE  HOSPITAL: 

IjL     Phosphori       ...         .         .     gr.  xxxii. 
Alcohol,  absol.       .         .         .  %}dvi. 

Tinct.  vanillae       .         .         .        .         J  i. 
Ol.  aurant.  cort.  ...       3  iii- 

Alcohol,  absol.  q.  s.  ad          .          3  xlviii. 


ANAEMIA.  13 

*  M.    Sig.  Twenty  minims  contain  gr.  -fa  of  phos- 
phorus. 

Concerning  the  benefit  derived  from  the  use  of 
cod  liver  oil,  DR.  JACOBI  finds  that  although  fre- 
quently of  great  service,  yet  in  his  experience  the 
centra-indications  are  often  overlooked.  Most  chil- 
dren, he  advises,  do  not  bear  it  well  in  the  summer 
time,  and  some  not  at  all.  In  all  cases,  moreover,  he 
cautions  that  whenever  digestion  is  impaired,  and 
gastric  catarrh  present,  preliminary  treatment  is 
required  before  the  administration  of  either  cod 
liver  oil  or  iron. 

The  following  is  DR.  W.  A.  HAMMOND'S  mixture  : 
$.    Ferri  pyrophosphat.    .         .         .          3  i- 
Quiniae  sulph.      .         .         .  3  i. 

Strychniae  .         .         .         .        gr.  i. 

Acid,  phosphor,  dil.  .         .         3  ii. 

Syrup,  zingib.      .         .         .         .          §  ii. 
Aquae  ad  ....         §  iv. 

M.    Dose  :  A  teaspoonful  or  less,  according  to  age. 
DR.  T.  GAILLARD  THOMAS  prescribes  the  follow- 
ing with  excellent  effect  for  the  anaemia  of  chlorosis, 

*  The  phosphorus   is   digested  with   absolute   alcohol,  with 
exclusion  of  air,  until  dissolved  ;  then  the  flavoring  ingredients 
are  added,  and  finally  the  bulk  is  made  up  with  absolute  alcohol 
to  fl.  5  xlviii. 


14  ANEMIA. 

occurring  in  young  girls  at  about  the  age  of  puberty: 

ty.  Ferri  vini  amari  .  .  .  §  viiss. 
Tinct.  nucis  vomicse  .  .  .  3  iv. 
Liq.  potass,  arsenit.  .  .  .  3  ii- 

M.  Sig.  A  dessertspoonful  in  a  glassful  of  water, 
just  after  each  meal. 

In  addition  to  this,  DR.  THOMAS,  regarding  the 
indications  as  being  to  remove  the  cause,  cure  the 
neurosis,  and  repair  the  damages,  advises  general 
tonic  treatment  and  the  observance  of  good  hygiene. 

DR.  J.  LEWIS  SMITH  aims  to  improve  and  build 
up  the  general  health  of  the  child  by  the  administra- 
tion of  the  ferruginous  and  vegetable  tonics,  and  by 
suitable  hygienic  measures.  The  following  is  one  of 
DR.  SMITH'S  favorite  tonic  formulas : 

]pfc.    Ferri  et  ammon.  cit. 

Ammon.  carbon.        .         .     aa  gr.  xxxii. 

Syrupi       .         .  • 

Aquae  anisi        .         .         .         .        aa  §  ii. 

M.    Sig.  A  teaspoonful. 

In  cases  of  anaemic  neuralgia  occurring  in  chil- 
dren of  from  eight  to  twelve  years — neuralgia  de- 
pendent upon  and  associated  with  anaemia — and 
which  he  finds  is  due  chiefly  to  a  condition  of  debil- 
ity, he  places  the  child  upon  a  most  nutritious  diet, 
consisting  largely  of  milk  and  beef,  and  directs  that 


ANEMIA.  15 

it  be  kept  away  from  school  for  a  season,  as  the 
study  and  strict  discipline  exacted,  together  with  the 
necessary  confinement  and  long  hours,  always  aggra- 
vate this  malady.  He  also  advises  that  plenty  of 
out-door  exercise  be  taken,  and  residence  in  the 
country  secured  if  possible  ;  together  with  regularity 
in  the  meals,  the  full  amount  of  sleep,  and  the  avoid- 
ance of  constipation. 

As  regards  medicinal  measures,  he  orders  a  moder- 
ate amount  of  alcoholic  stimulant,  as  a  teaspoonful  of 
brandy  in  milk,  taken  at  meals,  with  considerable 
satisfaction.  In  addition  to  this,  his  treatment  con- 
sists in  the  administration  of  any  of  the  vegetable 
bitters  with  iron.  The  following  combination  is  a 
favorite  with  him  in  these  cases,  and  from  its  use 
he  has  often  obtained  marked  and  usually  prompt 
benefit ;  this  formula  is  also  very  extensively  used 
at  Bellevue  Hospital : 

$.    Ferri  et  potass,  tart.       .         .  3  i- 

Tinct.  cinchonae  co.        .         .  §  iv. 

M.  Sig.  A  teaspoonful  in  a  little  water,  four  times 
daily. 

In  some  instances,  under  this  treatment,  the  head- 
ache, even  of  months  standing,  has  ceased  in  less 
than  two  weeks. 

DR.  SMITH  also   derives   much  good  from  stint- 


16  ANAEMIA. 

ulating  and  irritating  applications  along  the  spine. 
When  the  pain  is  in  the  trunk,  he  never  employs  a 
lengthened  blister,  or  any  blister  over  the  spine,  as 
recommended  by  some,  but  usually  prefers  a  stimu- 
lating application,  as  an  ammoniacal  mixture ;  or 
the  following  is  much  relied  upon  by  him  for  this 
purpose : 

Ijfc.    Olei  terebinthinae    .... 

Linim.  saponis  camphorat.     .         .     e.  p. 
M.    Sig.  To  be  applied  with  brisk  friction,  several 
times  daily. 

Or  he  frequently  obtains  considerable  temporary 
relief  from  the  use  of  dry  cups,  applied  in  three  or 
four  places  over  the  spine,  and  along  its  side  oppo- 
site the  seat  of  pain.  But  for  permanent  good,  he 
places  the  greatest  reliance  upon  constitutional 
remedies. 

In  some  instances,  he  advises,  there  is  also  more 
or  less  palpitation,  and  frequently  anaemic  heart  mur- 
murs are  heard ;  or  sometimes  an  occasional  short 
and  painless  cough,  without  expectoration,  is  present. 
In  such  cases,  he  has  found  the  following  prescrip- 
tion of  most  valuable  service  : 

Tfr.    Ferri  sulphat 3ss. 

Acid  nitric.           .         .         .        .    fl.  3  ss. 
Aquae  destill §  ss. 


ANAEMIA.  17 

M.  Sig.  Four  drops,  four  times  daily,  in  sweet- 
ened water. 

This  cough,  he  finds,  may  also  be  relieved  by  the 
use  of  belladonna  and  the  bromides,  but  at  the  same 
time  advises  that  iron,  tonics,  and  careful  attention  to 
hygiene,  must  constitute  the  chief  means  of  treat- 
ment. 

In  anaemic  girls  at  the  age  of  puberty,  and  es- 
pecially if  chlorotic,  DR.  A.  H.  SMITH  prescribes  the 
following  tonic  mixture,  from  the  use  of  which  he 
has  obtained  the  most  gratifying  results : 

1$.  Hydrarg.  chlorid.  corros.  .  .  gr.  i-ii. 
Liq.  arsenici  chloridi  .  .  .  fl.  3  i. 
Tinct.  ferri  chloridi 

Acid,  hydrochlor.  dil.  .  aa  fl.  3  iv. 
Syrupi  .  .  .  .  .  fl.  §  iii. 
Aquae  ad fl.  §  vi. 

M.  Sig.  One  to  two  teaspoonfuls  in  a  wineglass- 
ful  of  water,  after  each  meal. 

This  should  not,  however,  be  continued  for  more 
than  two  weeks  at  a  time. 

DR.  ALONZO  CLARK  varies  his  treatment  some- 
what according  to  the  associated  condition.  Besides 
the  use  of  constitutional  remedies,  where  there  is 
also  anorexia,  nausea  and  vomiting,  and  constipa- 
tion, he  causes  a  free  movement  of  the  bowels,  and 

2 


1 8  ANAEMIA. 

directs  that  they  be  kept  in  an  active  condition.  He 
then  endeavors  to  aid  digestion  and  to  improve  the 
general  health  by  the  administration  of  medicinal 
remedies,  such  as  pepsin  and  nitro-muriatic  acid, 
together  with  good,  nutritious  food,  and  by  the 
maintenance  of  good  hygiene.  If  head  symptoms 
are  present,  these,  he  finds,  also  disappear  as  the 
patient  improves. 

DR.  BEVERLY  ROBINSON  prescribes  the  following 
with  great  satisfaction,  in  those  cases  of  progressive 
pernicious  anaemia  occurring  in  young  girls  at  or 
about  the  time  of  puberty : 

Ijfc.    Ext.  cascarae  sagradae  fl.            .  3ss. 

Aquae §  ss. 

M.   Sig.  Dose,  at  bedtime. 

This  is  also  to  be  repeated  in  the  morning  if  re- 
quired. In  conjunction  with  the  above  he  then 
administers : 

#.    Pil.  ferri  carbon.  (Vallet)          .         No.  x. 
Sig.  One  three  times  daily,  with  meals. 

Under  this  treatment  benefit  has  followed  in  a 
very  short  time. 


RACHITIS.  19 

RACHITIS. 


In  treating  these  cases  in  infants,  DR.  A.  JACOBI 
first  advises  keeping  the  child  in  as  uniform  a  tem- 
perature as  possible,  not  allowing  the  room  to  get 
too  hot,  but  maintaining  an  even  temperature  of 
about  70°,  with  a  slight  degree  of  moisture  in  the  air 
by  means  of  steam.  An  abundance  of  fresh  air  is 
also  secured  through  proper  ventilation  ;  this,  he 
finds,  is  worthy  of  the  highest  consideration,  and  its 
importance  cannot  be  over-estimated.  He  further 
directs  that  the  child  be  bathed  regularly  and  at 
more  frequent  intervals  than  usual,  at  least  every 
morning  and  night.  For  this  purpose  the  cold  water 
bath,  with  perhaps  a  little  salt  in  it,  is  used,  and  the 
child  warmly  clothed  afterward. 

Where  a  baby  of  one  year  is  still  at  the  breast,  as 
is  often  the  case,  he  insists  that  it  be  weaned  at 
once,  as  the  rachitis  is  probably  more  or  less  de- 
pendent upon  the  character  of  the  mother's  milk. 
In  doing  this,  farinaceous  foods,  such  as  barley  and 
oat-meal  mixed  with  boiled  cow's-milk,  are  gradually 
substituted  for  the  breast-milk.  He  advises  discrim- 
ination, however,  in  the  use  of  barley  and  oat-meal, 
according  to  the  condition  of  the  bowels.  If  the 
bowels  incline  to  be  constipated,  oat-meal  is  pre- 
ferred ;  but  where  diarrhoea  is  present,  barley  is  used 


2O  RACHITIS. 

because  of  its  tendency  to  constipation.  Besides 
these,  beef-tea  or  soup  are  also  added  to  the  diet. 
In  older  children,  that  is  to  say,  of  two  or  three 
years  of  age,  he  directs  that  plenty  of  beef  and  eggs 
be  given  in  addition ;  but  where  the  general  ill- 
nutrition  is  very  marked,  with  a  flabby  condition  of 
the  muscles,  and  constipation,  DR.  JACOBI  places  the 
child  on  a  diet  consisting  of  a  few  teaspoonfuls  of 
raw  meat  and  one  egg  in  the  twenty-four  hours, 
together  with  plenty  of  oat-meal  with  cow's-milk. 
Moreover,  too  much  milk,  he  advises,  may  prove  in- 
jurious by  forming  a  superabundance  of  lactic  acid 
in  the  stomach  and  intestines. 

Regarding  direct  treatment,  it  is  questionable  with 
him  whether  any  is  necessary,  in  a  great  many  cases. 
He  does  not  generally  care  to  give  much  medicine 
directly,  provided  he  can  harden  and  toughen  the 
child  by  cold  water  bathing  and  proper  food.  When 
there  is  much  cough  present,  opium  is  occasionally 
required.  As  a  rule,  however,  and  especially  where 
there  is  more  or  less  glandular  enlargement,  he  gives 
the  iodides,  preferring  the  following  as  one  of  the 
best  preparations : 

"fy.     Syrupi  ferri  iodidi        .         .      gtt.  viii-x. 
Aquae       .        .         .         .         .         .  q.  s. 

M.    Sig.  Dose,  three  times  daily. 

In  addition  the  salts  of  sodium   and  calcium  are 


RACHITIS.  21 

usually  given  in  fair  quantity.  In  many  cases  he 
also  combines  the  above  with  cod  liver  oil,  in  doses  of 
3  i,  three  times  daily.  The  following  emulsion  is 
very  much  used  at  BELLEVUE  HOSPITAL  : 

9-    Olei  morrhuse 

Aquae  calcis        .        .         .      aafl.  §  viii. 

Olei  cinnamomi      .         .        .         gtt.  x. 
M. 

In  cases  where  the  child  is  also  subject  to  the  fre- 
quent occurrence  of  convulsions,  or  even  with  symp- 
toms of  meningitis  present,  DR.  JACOBI  considers  it 
vastly  more  important  to  improve  the  general  con- 
dition, to  insure  good  hygiene,  fresh  air,  and  nourish- 
ing food,  than  to  treat  the  convulsions,  which  are 
but  manifestations  of  the  constitutional  condition. 
In 'these  children,  he  often  finds  that  if  plenty  of 
oxygen,  in  the  shape  of  fresh  air,  is  obtained,  the 
convulsions  cease  of  themselves  without  any  medici- 
nal resort.  This  abundance  of  air,  he  advises,  must 
also  be  secured  during  the  night,  as  well  as  the  day, 
by  means  of  proper  and  thorough  ventilation. 

Under  this  plan  of  treatment  the  results,  in  his 
experience,  have  been  very  favorable.  And  even  in 
cases  where  there  is  softening  of  the  costal  ends  of 
the  ribs,  with  a  tendency  to  fractures  of  the  bones 
of  the  arms,  leg,  and  thigh — or  rather  infractures — 


22  RACHITIS. 

he  finds  this  general  anti-rachitic  treatment  very 
beneficial.  The  fractures  heal  and  general  improve- 
ment in  the  condition  of  the  child  takes  place.  Later 
on,  when  the  health  is  greatly  improved,  he  remedies 
whatever  defect  may  have  taken  place  in  the  union 
of  the  bones,  by  refracturing  them  and  permitting 
them  to  unite  in  a  better  position.  Before  this 
period,  however,  he  often  observes  that  all  that  is 
necessary  is  to  bend  the  bones  back  again  and  retain 
them  in  their  normal  position. 

In  the  treatment  of  all  cases,  moreover,  caution  is 
advised  in  distinguishing  between  rachitis  due  to 
syphilis,  and  those  which  are  not ;  as  in  the  latter 
mercurials  would  never  be  employed,  while  in  the 
former  they  are  necessary  to  the  cure. 

In  treating  the  sequela  of  rachitis,  found  in  older 
children,  where  the  pigeon  breast,  etc.,  is  prominent, 
DR.  JACOBI'S  main  object  is  to  expand  the  lungs 
and  to  change  the  shape  of  the  chest.  Even  where 
the  disease  is  of  long  standing,  he  advises  that  it  is 
possible,  though  not  very  probable,  that  the  adminis- 
tration of  potassium  iodide  will  assist  somewhat  in 
causing  a  resolution  of  the  induration  in  the  lungs, 
which  is  not  infrequently  present.  Where,  however, 
the  lung  tissues  have  undergone  constant  changes, 
he  thinks  it  will  prove  of  little  value.  But  since 
similar  conditions  are  sometimes  benefited  by  this 


RACHITIS.  23 

remedy,  he  recommends  that  it  be,  at  least,  tried  in 
these  cases ;  it  will  also  act  beneficially  on  the 
chronic  bronchitis,  which  is  often  a  troublesome 
feature.  In  administering  the  drug,  he  sometimes 
gives  it  in  combination  with  the  iodide  of  iron,  for  a 
time,  with  great  benefit.  The  following  method  is 
much  used  at  BELLEVUE  HOSPITAL : 

Ijfc.    Potassii  iodidi         .         .         .         .     3iv. 
Syrupi  ferri  iodidi       .        .        .  5  i. 

Tinct.  calumbae  q.  s.  ad.         .  §  iv. 

M.  Sig.  Half-  to  a  teaspoonful. 
DR.  JACOBI  also  directs  that  a  good,  nourishing 
and  mixed  diet  be  administered,  such  as  beef,  eggs, 
milk,  farina,  oatmeal,  etc.;  but  coffee,  tea,  and 
stimulants  are  strictly  prohibited.  Open  air  exercise, 
play  out  of  doors,  gymnastics,  the  use  of  dumb-bells, 
etc.,  are  also  required,  together  with  cold  bathing; 
and  during  the  winter  cod  liver  oil  should  be  taken 
to  increase  nutrition. 

The  following  is  the  formula  for  the  emulsion  of 
cod-liver  oil  used  at  ROOSEVELT  HOSPITAL : 
$.    Olei  morrhuae      .         .        .         .         3ii. 
Spts.  lavandulae  co. 

Spts.  vini  gall aa  3  i. 

M. 

DR.  W.  H.  THOMSON  finds  that  the  best  time  to 


24  SCROFULOSIS. 

give  cod-liver  oil,  when  regarded  as  a  food,  is  about 
one  and  one-half  hours  after  a  meal,  as  then  the 
stomach  is  acting  rapidly,  and  the  oil  is  passed 
directly  into  the  duodenum,  where  it  can  be  readily 
emulsified  by  the  pancreatic  and  intestinal  juices. 


SCROFULOSIS. 


Of  all  the  remedies  employed  in  the  treatment  of 
the  strumous  diathesis  of  young  children,  DR.  J. 
LEWIS  SMITH  believes  that  the  oxide  of  iron  is  ap- 
parently the  best.  This  he  gives  in  doses  of  gtt.  i. 
for  each  year  in  the  age  of  the  child.  In  many 
cases  of  marked  strumous  aspect,  he  gives  the  fol- 
lowing with  great  benefit : 

Tfi.    Syrupi  ferri  iodidi  .         .         .        gtt.  iii. 
Aquae q.  s. 

M.    Sig.  Dose,  thrice  daily,  to  a  child  of  one  year. 

In  conjunction  with  this  he  also  administers  cod- 
liver  oil.  Where  from  the  presence  of  an  inflamed 
condition  of  the  nostrils,  fissures  of  the  lips,  etc.,  the 
suspicion  exists  that  a  syphilitic  cachexia  lies  at  the 
bottom  of  the  case,  he  resorts  to  the  application  of 
the  mercurial  ointment,  as  follows : 


SCROFULOSIS.  25 

Ijfc.    Pulv.  zinci  oxidi     .         .        .         .       3  i. 
Ung.  hydrarg.  nitrat.          .         .  3  ii- 

Oleo-paraffini  (Vaseline)         .         .        j§  i. 
M.    Sig.  To  be  applied  four  or  five  times  daily. 
If  stomatitis  is  also  present,  he  makes  use  of  the 
following  with  much  satisfaction : 

1$.    Potass,  chlorat.     .         .         .         .         3i. 

Tinct.  ferri  chlor 3  i. 

Glycerinse    .         .         .         .         .        §ss. 

Aquae %ss. 

M.    Sig.  A  teaspoonful  every  three  hours. 
In  cases  of  scrofulous  glandular  enlargements,  and 
particularly  where  there  is  also  much  itching  present, 
DR.  SMITH  finds  the  following  ointment  very  effica- 
cious: 

Ijfc .    Ung.  hydrarg.  nitratis         .        .         3  ii- 
Pulv.  zinci  oxidi     .         .         .         .      3  ii. 
Acid,  carbol.       .         .        .         .    gr.  xiv. 
Oleo-paraffini  (Vaseline)         .         .    §  iss. 
M.    Sig.  Apply  by  inunction. 
The  carbolic  acid,  he  advises,  is  usually  of  excellent 
service  in  allaying  the  itching  in  these  cases.     Or, 
in  certain  instances,  he  uses  iodine  with  good  effect 
on  the  adenitis,  thus : 

Ijfc.    Sol.  iodinii  co 

Glycerinae          .         .         .         .        aa  §  i. 
M.    Sig.  To  be  applied  by  inunction. 


26  SCROFULOSIS. 

DR.  A.  JACOBI  advises  that  in  cases  of  strumous 
abscesses  about  the  neck,  after  opening  the  abscess 
and  evacuating  its  contents,  he  finds  it  an  excellent 
plan  to  keep  the  opening  patent  by  means  of  lint 
soaked  in  a  two  per  cent,  solution  of  carbolic  acid. 

DR.  F.  N.  OTIS  obtains  very  marked  benefit,  in 
scrofulous  children,  from  the  administration  of  iodine 
in  combination  with  Stuart's  syrup.  The  method 
he  uses,  and  which  he  considers  to  be  a  most  valu- 
able prescription,  is  thus  formulated  : 

IjL    lodinii  ....         gr.  xxiv. 

Potass,  iodidi 3  i- 

Aquae  destill.        .         .         .         .         §  ii. 

Solve  et  add. 

Stuart's  syrup  (or  plain  molasses)        §  vi. 

M.  Sig.  A  dessert-  to  a  tablespoonful  three  or  four 
times  daily. 

He  has  been  accustomed  to  giving  this  to  these 
children  for  many  years,  and  in  quantities  that  one 
would  hardly  suppose  would  be  borne  ;  and  which, 
he  moreover  believes,  would  certainly  not  be,  if  the 
iodine  were  given  in  any  other  form. 


ACUTE   RHEUMATISM.  2? 


ACUTE  RHEUMATISM. 


DR.  W.  H.  DRAPER  advises  that  the  patient 
should  be  made  as  comfortable  as  possible  in  bed, 
and  absolute  rest  secured.  Rest  he  considers  one  of 
the  most  important  therapeutic  measures,  and  be- 
lieves that  no  detail  in  this  direction  is  too  small 
for  the  personal  attention  of  the  physician.  It  puts 
the  circulation  in  the  best  possible  condition,  and 
helps  to  avoid  complications.  He  therefore  resorts 
to  every  necessary  means  to  obtain  rest  and  sleep, 
freedom  from  mental  and  emotional  changes,  to  alle- 
viate the  pain,  and  to  relieve  the  suffering.  Position 
he  also  considers  an  important  factor  in  the  treat- 
ment. The  position  of  the  affected  limbs  is  made 
restful,  and  most  comfortable  for  the  patient.  To 
accomplish  this  he  finds  it  a  good  plan  to  put  the 
joints  up  in  splints,  or  pillows  are  used  for  supports, 
if  necessary ;  this  not  only  saves  a  good  deal  of  suf- 
ering,  but  lessens  the  amount  of  anodynes  needed. 
Where  the  pain  is  too  severe  opium  is  given,  in 
whatever  form  is  most  agreeable.  This  he  finds  is  a 
very  valuable  aid  in  the  treatment,  and  advises  that 
the  benefit  gained  thereby  should  never  be  denied 
the  patient. 


28  ACUTE   RHEUMATISM. 

The  diet  is  another  prominent  feature  which,  in  his 
opinion,  should  receive  the  most  careful  considera- 
tion. This,  he  advises,  should  be  controlled  in  every 
case,  both  in.  acute  and  chronic  disease,  for  by  at- 
tending to  the  diet  the  recurrence  of  the  malady  may 
be  prevented.  The  patient  should,  therefore,  not  be 
over-fed.  The  food  is  made  simple,  consisting  of 
milk,  which  he  considers  best,  together  with  animal 
broths,  but  no  starches  and  sugars,  and  little  bread. 
Gruels  and  farinaceous  slops  are  believed  by  him  to 
be  the  source  of  much  mischief.  All  the  water 
needed  is  allowed  and,  in  many  instances,  mineral 
water  is  given,  which  he  finds  very  beneficial. 

Regarding  medication,  DR.  DRAPER  calls  attention 
to  the  great  variety  of  drugs  which  have  gained  a 
reputation  as  curative  in  this  affection,  due  to  the 
variation  in  the  duration  of  the  disease.  As  a  rule, 
however,  he  finds  that  all  cases  will  yield  to  the 
salicylic  acid  treatment,  which  is  preferred  by  him. 
This  he  administers  as  follows : 

IJ.     Acid,  salicylic.  gr.  x. 

Sig.  Dose,  every  two  or  three  hours,  to  a  child  of 
ten  years. 

Under  this  treatment  the  tenderness,  pain,  and 
discomfort  usually  disappear,  the  fever  subsides,  and 
the  patient  enters  upon  convalescence  often  within 
twenty-four  hours,  or  in  periods  varying  from  one  to 


ACUTE   RHEUMATISM.  29 

three  or  four  days.  In  his  experience  the  salicylate 
treatment  of  acute  rheumatic  fever  is,  as  a  rule,  uni- 
formly successful,  and  no  drug  is  shown  to  be  so  ser- 
viceable ;  it  actually  cuts  short  the  attack,  and  so 
long  as  the  patient  is  under  its  influence  improve- 
ment continues.  He  cautions,  however,  that  the 
tendency  to  relapse  should  always  be  borne  in  mind, 
in  using  this  treatment,  and  even  after  recovery  has 
apparently  taken  place,  the  patient  is  kept  at  rest 
and  the  administration  of  the  drug  continued,  in 
diminished  doses,  for  a  period  of  one  or  two  weeks ; 
otherwise  a  relapse  will  almost  invariably  occur. 

Regarding  complications,  a  great  deal,  he  believes, 
can  be  done  to  prevent  them  by  careful  attention  to 
treatment,  by  good  nursing,  and  by  a  proper  and 
judicious  diet.  They  should,  however,  be  constantly 
watched  for,  and  the  patient  never  visited  without 
examining  for  endocardial  affection. 

Concerning  the  use  of  blisters,  in  certain  cases  DR. 
DRAPER  applies  a  blister  to  the  joint  with  much 
benefit ;  but  he  advises  that  this  should  not  be  re- 
sorted to  in  acute  attacks,  where  there  is  much  swell- 
ing and  fever.  For,  at  the  best,  he  finds  that  local 
irritation  is  not  of  much  value,  but  from  being  em- 
ployed by  some  in  these  acute  attacks,  an  erroneous 
opinion  is,  he  believes,  formed  of  its  merits.  In  sub- 
acute  forms,  however,  where  there  is  a  moderate  de- 


30  ACUTE   RHEUMATISM. 

gree  of  synovial  inflammation  and  moderate  thicken- 
ing about  the  joint,  the  value  of  blistering  is  found 
to  be  greatly  enhanced,  and  excellent  results  are 
often  obtained  by  him  from  their  application.  The 
following  is  used  as  an  anti-rheumatic  at  the  NEW 
YORK  HOSPITAL  : 

Ijfc.    Potass,  iodidi  .         .         .         .      3v. 

Vini  colchici  sem.  .         .  §  i. 

Tinct.  cimicifugae  rac.  .  §  ii. 

Tinct.  stramon 5  ss- 

Tinct.  opii  camphor.        .         .         .    §  iss. 
M. 

DR.  A.  JACOBI  places  the  child  upon  the  adminis- 
tration of  salicylate  of  soda,  with  very  satisfactory 
results.  The  pain,  fever,  and  other  symptoms  dis- 
appear, and  convalescence  is  established  often  in 
a  very  short  time. 

DR.  J.  H.  RlPLEY  prescribes  the  salicylic  acid 
treatment  as  follows : 

9>.    Acid,   salicylici         .        .        .  3  ii. 

Sodii  bicarbon.          ...  3  iss. 

Aquae  ad  ....  ^  iv. 

M.  Sig.  A  dessertspoonful  every  two  or  three 
hours. 

DR.  ALONZO  CLARK  sometimes  uses  the  alkaline 
treatment,  or  in  many  cases  he  administers  the 


ACUTE   RHEUMATISM.  3! 

salicylate  of  soda,  in  doses  of  gr,  viii.-x,  every  two  or 
three  hours  during  the  first  day,  and  the  same  amount 
at  longer  intervals  on  the  second  day.  Under  this 
treatment  he  usually  succeeds  in  controlling  the  dis- 
ease in  periods  varying  from  one  to  three  or  four 
days,  and  in  many  instances  within  a  few 
hours.  Where  much  disturbance  of  the  stomach  re- 
sults from  its  use,  he  gives  the  drug  by  injection  with 
equal  benefit.  In  all  cases,  however,  he  considers  it 
of  the  highest  importance  to  make  daily  examination 
of  the  heart.  The  cardiac  disease,  he  finds,  usually 
follows  the  articular  trouble  on  about  the  fifth  day ; 
hence  he  advises  the  importance  of  obtaining  an 
early  control  over  the  rheumatic  affection,  and  thus, 
if  possible,  prevent  the  heart  lesion. 

DR.  W.  H.  THOMSON  prefers  the  following  plan  of 
administering  the  salicylate  treatment,  which  is, 
moreover,  a  favorite  prescription  with  him : 

1$.  Sol.  acidi  salicylici  .  .  .  §  ii. 

Tinct.  gaultheriae  .  .  .  31. 

Aquae  ad             .  .  .  .  §  iv. 
M. 

DR.  AUSTIN  FLINT  prescribes  the  salicylate  treat- 
ment, using  either  the  acid  or  the  soda  salt.  In  the 
treatment  of  acute  rheumatism  with  salicylic  acid, 
however,  he  advises  that  although  the  administra- 


32  ACUTE   RHEUMATISM. 

tion  of  this  drug  occasionally  causes  the  disease  to 
abort,  or,  at  least,  shortens  its  duration,  yet  it  should 
not  supersede  the  alkaline  treatment,  nor  should  the 
alkaline  treatment  be  relinquished.  This  latter  he 
carries  to  its  full  extent,  as  usual,  since  although  it 
does  not  exert  a  marked  effect  on  the  duration  of 
the  disease,  yet  it  diminishes  the  liability  to  pericar- 
ditis and  endocarditis,  which  has  not  been  shown  for 
salicylic  acid.  In  fact,  he  finds  that  since  the  use  of 
the  salicylate  treatment,  cardiac  affections  have  be- 
come more  common  than  before.  This  he  considers 
to  be  of  the  highest  practical  importance.  There- 
fore, when  giving  this  drug  he  also  combines  the  al- 
kalies with  it,  in  sufficient  quantity  to  render  the 
urine  alkaline  as  speedily  as  possible ;  thus  : 

]jfc.    Mist.  acid,  salicylici  (gr.  xlv-§i)     .      §  ii. 

Sodii  bicarbon 3  ii. 

M. 

And  if  this  is  done  at  the  commencement  of  the 
rheumatic  attack,  he  believes  that  heart  trouble 
would  in  a  great  many  instances  be  prevented.  Rest 
and  quiet  are  also  important  points  in  his  treat- 
ment. 

Moreover,  while  DR.  FLINT  places  great  reliance 
on  the  salicylate  treatment,  he  has  also  used  the  bcn- 
zoate  of  soda  (as  recommended  by  German  authori- 


ACUTE   RHEUMATISM.  33 

ties)  experimentally  in  this  disease.  His  results, 
however,  go  to  show  that  although  this  agent  does 
exert  a  certain  amount  of  influence  on  the  course  of 
the  malady,  yet  its  effect  is  not  to  be  compared  to 
that  attending  the  administration  of  salicylic  acid  or 
salicylate  of  soda. 

At  the  HART'S  ISLAND  HOSPITAL  (for  children) 
the  following  anti-rheumatic  mixture  is  extensively 
used ; 

^fc.    Potass,  iodidi        .        .         .  .         §1. 

Potass,  acetat.          ...  §  iv. 

Tinct.  colchici  sem.      .         .  .        §  ii. 

Aquae Oii. 

M.    Dose  :  A  teaspoonful. 

At  BELLEVUE  HOSPITAL  salicylic  acid  is  very  gen- 
erally employed,  and  with  excellent  results.  In  some 
cases  delirium  is  caused  by  its  administration,  partic- 
ularly where  a  liberal  exhibition  of  the  drug  has  been 
made  ;  this  quickly  subsides,  however,  when  the  ex- 
citing cause  is  removed,  or  under  the  use  of  opiates 
or  the  bromides.  In  hearty,  robust  children  of  from 
nine  to  twelve  years  of  age,  the  patient  is  put  to  bed 
and  salicylic  acid  gr.  x.  every  three  hours  administered; 
giving  the  following  solution  which,  in  many  instan- 
ces, is  found  to  agree  better  with  the  stomach  and  is 
much  used,  especially  in  children  : 


34  ACUTE   RHEUMATISM. 

IjL    Acid,  salicylici  .         .         .  §  ss. 

Sodii  bicarbon.  ....  q.s. 

Syrupi  zingib.  .         .         .         .  3  ii. 

Aquae  ad  ....  §  vi. 

M.    Sig.  §  ss.  contains  gr.  xx. 

Should  delirium  occur  after  a  few  doses  have  been 
taken,  the  administration  is  stopped  and  the  follow- 
ing given  instead  : 

IjL    Potassii  bromid.          .         .        .        gr.x. 
Aquae q.s. 

M.    Sig:  Dose. 

This  may  be  repeated  a  few  times  until  the  delir- 
ium ceases. 

The  salicylate  treatment  is  also  employed  at 
ROOSEVELT  HOSPITAL,  the  method  being  formu- 
lated thus : 

IJ.    Acidi  salicylici         .         .         .  gr.clx. 

Sodii  bicarb 

Potass,  bicarb.           .        .        .  aa  3  ii. 

Syrupi  limonis     .         .         .         .  §  i. 

Aquae  ad          ....  §  iv. 

M.    Sig.  A  dessertspoonful  to  a  child  of  ten  years. 

At  CHARITY  HOSPITAL  the  following  anti-rheu- 
matic mixture  is  prescribed : 


SYPHILIS.  35 

1$.    Sodii  et  potass,  tart.  .         .  §ss. 

Vini  colchici  sem.  ...  3  ii. 

Aquae  q.s.  ad  .         .         .  §  ii. 

M.    Dose  :  A  teaspoonful. 


SYPHILIS. 


In  the  treatment  of  syphilis,  mercury  in  some  form 
or  other  is  the  very  generally  accepted  remedy.  The 
method  of  administration,  however,  is  principally  the 
variation  in  treatment  with  different  practitioners. 

DR.  J.  LEWIS  SMITH,  in  many  instances,  prefers 
the  bichloride,  and  uses  the  following  with  very  sat- 
isfactory results : 

1ft.    Hydrarg.  bichlorid.   .         .         .  gr.ss. 
Potass,  iodidi        .... 

Ferri  et  ammon.  cit.         .         .  aa  3  i. 

Syrupi §  vi. 

M.  Sig.  A-  teaspoonful  three  times  daily,  to  a 
child  three  to  five  years  old. 

Or,  where  the  general  health  is  poor,  the  follow- 
ing prescription  is  found  by  him  to  be  of  marked 
benefit : 


36  SYPHILIS. 

Ijfc.     Hydrarg.  bichlorid.          .         .         gr.i-ii. 
Syrupi  sarsaparil.  co.  .         .          3  ii. 

Aquae       .....          §  viii. 

M.    Sig.  A  teaspoonful  three  times  a  day. 

DR.  F.  N.  OTIS  gives  mercury  in  small  doses  until 
a  little  impression  is  manifest ;  he  then  diminishes  the 
amount  for  a  time  until  this  effect  has  disappeared, 
when  the  administration  is  again  renewed.  In  giving 
the  drug  he  uses  blue  mass  in  a  great  majority  of 
cases.  In  syphilis  where  there  are  scrofulous  enlarge- 
ments, he  advises  that  it  is  best  to  leave  off  the  mer- 
curial treatment  at  as  early  a  period  as  possible. 
After  continuing  it  for  some  time,  if  the  evidences  of 
syphilis  have  passed  entirely  away  and  no  new  symp- 
toms present  themselves,  he  generally  omits  the  mer- 
cury and  gives  some  milder  preparation  in  connec- 
tion with  potassium  iodide.  In  these  scrofulous 
cases  DR.  OTIS  is  in  the  habit  of  using  iodine  very 
freely,  instead  of  the  iodide  of  potassium,  and  finds 
it  not  only  equally  effective,  but  these  constitu- 
tions are  also  braced  up  and  benefited  by  it.  In 
giving  it  he  uses  Stuart's  syrup,  which,  in  his  ex- 
perience, is  superior  to  any  other  vehicle.  He  has 
prescribed  this  for  many  years  and  finds  it  an  exceed- 
ingly valuable  preparation  ;  the  formula  employed 
by  him  for  this  purpose  is  as  follows : 


SYPHILIS.  37 

$.    lodinii gr.xxiv. 

Potass,  iodid 3  i. 

Aquae  destill.  ...  §  ii. 

Solve  et  add. 

Stuart's  syrup  (or  plain  molasses)        ^  vi. 
M.     Sig.  A  dessert-  to  a   tablespoonful  three  or 
four  times  daily. 

By  this  combination  he  is  able  to  give  iodine  in 
very  large  quantity  and  for  a  long  time,  without  any 
distaste  and  without  disturbing  the  stomach. 

The  above  plan  of  treatment  DR.  OTIS  considers 
particularly  valuable  in  cases  of  syphilis  where  there 
is  also  scrofula. 

At  CHARITY  HOSPITAL  the  following  mixture  is 
very  considerably  used  : 

1$.    Potass,  iodid 3  iv. 

Syrup,  sarsap.  co. 

Tinct.  gent.  co.  ...      aa  §i. 

M. 

DR.  R.W.  TAYLOR  has  made  the  subject  of  infantile 
syphilis  his  especial  study,  and,  in  his  experience, 
the  following  formula  and  method  of  administration 
are  of  the  greatest  efficacy ; 

Ijfc.    Hydrarg.  bichlorid.  gr.  i. 

Potass,  iodidi     .         .         .         .          3  iv. 
Syrup,  aurantii 
Aquae          .  .         .        .     aa  3  "• 


38  SYPHILIS. 

M.  Sig.  Five  drops,  for  a  child  about  two  months 
old. 

This  amount  he  then  increases  to  gtt.  xv-xx,  if 
the  disease  does  not  yield.  He  advises,  however, 
that  it  is  important  to  suspend  the  medicine  alto- 
gether, from  time  to  time,  as  the  system  acquires  a 
tolerance  for  it. 

DR.  G.  H.  Fox  uses  the  bichloride  of  mercury  in 
small  doses  very  effectually,  in  cases  of  infantile 
syphilis.  In  tubercular  forms,  he  often  finds  rapid 
improvement  from  the  administration  of  potassium 
iodide  internally,  combined  with  the  external  applica- 
tion of  mercurial  ointment.  Or,  in  older  children  and 
where  the  case  is  of  long  standing,  with  debility,  loss 
of  appetite,  etc.,  he  orders  mercury  and  potassium 
iodide  in  compound  syrup  of  sarsaparilla,  to  be  taken 
internally,  in  conjunction  with  the  local  application. 
Should  the  latter  cause  too  much  irritation  of  the  skin 
it  is  omitted,  continuing  the  mixed  treatment. 
Marked  benefit  usually  follows.  Frequently,  how- 
ever, as  improvement  takes  place  the  medicine 
causes  nausea  and  sickness  at  the  stomach  •  he  then 
stops  the  mercury  and  administers : 

Jfr.    Potassii  iodidi     ...  gr.  ii-v. 

Aquae          .         .         .         .         .         q.  s. 

M.    Sig.  To  be  taken  three  times  daily. 


SYPHILIS.  39 

In  regard  to  the  use  of  mercury  and  other  rem- 
edies in  the  treatment  of  syphilis,  DR.  Fox  main- 
tains that  while  it  is  a  most  valuable  remedy,  yet 
mercury  is  an  overrated  drug,  and  is  not  essential  to 
the  cure  of  the  disease.  He  believes  that  it  is  best 
administered  internally  rather  than  by  inunction,  by 
vapor  baths,  or  by  hypodermic  injection.  In  his  ex- 
perience, also,  the  amount  usually  given  is  unneces- 
sarily large,  and  its  local  irritant  effects  should  be 
avoided.  As  regards  the  duration  of  its  use,  this 
should  vary  according  to  the  severity  of  the  case  ; 
no  absolute  rule  is  advised.  Iodide  of  potassium^  he 
thinks,  should  not  be  reserved  entirely  for  the  later 
stage  of  the  disease,  for  there  is  no  period  in  which 
either  iodine  or  mercury  is  not  capable  of  doing 
good.  Moreover,  instead  of  the  so-called  "  mixed 
treatment,"  he  prefers  to  give  the  two  agents  separ- 
ately. Potassium  iodide,  he  finds,  ought  not  to  be 
given  continuously  for  any  great  length  of  time,  as 
it  acts  quickly  or  not  at  all,  and  when  unnecessarily 
continued  is  sure  to  do  harm.  Also,  very  large  doses 
should  not  be  administered  without  the  strongest 
indications ;  he  believes  they  are  of  value  in  certain 
cases,  but  advises  that  iodism  has  often  been  mis- 
taken for  the  exhibition  of  syphilis.  Iron  is  con- 
sidered by  DR.  Fox  as  deserving  to  be  ranked  with 
mercury  and  iodide  of  potassium,  from  its  effects  on 


40  SYPHILIS. 

the  anaemia  that  invariably  accompanies  the  early 
stage.  Cod  liver  oil  is  also  a  remedy  which  he  finds 
of  great  value,  especially  where  there  is  a  strumous 
condition  present. 

The  following  is  found  very  serviceable  at  BELLE- 
VUE  HOSPITAL  : 

Ijfc.    Hydrarg.  chlor.  corros.        .         .        gr.  i. 
Potass,  iodidi      .         .         .         .  3  ii. 

Tinct.  gent.  co.  .        .         .         §  iv. 

M. 

DR.  W.  H.  DRAPER  obtains  excellent  results  from 
the  administration  of  constitutional  treatment.  In 
hereditary  cases  he  advises  the  great  importance  of 
early  diagnosis.  The  mild  or  the  bi-chloride  are  often 
used,  but  he  considers  the  prot iodide  as  probably  the 
best  method  of  giving  the  drug,  it  being  more  active 
than  the  former  preparation.  If  diarrhoea  is  pro- 
duced, opium  may  be  added.  He  also  calls  atten- 
tion to  the  fact  that  although  these  patients  can  take 
mercury  and  iodine  to  an  almost  unlimited  extent, 
yet  the  susceptibility  varies  considerably,  which 
should  constantly  be  borne  in  mind.  When  ad- 
ministration by  the  mouth  is  contraindicated  or  im- 
practicable, he  finds  inunction  the  best  method.  An 
ointment  of  mercnry  rubbed  up  with  fat  is,  in  his 
experience,  superior  to  the  old  form  of  ointment, 


SYPHILIS.  41 

Sometimes  tonics,  quinia,  etc.,  are  also  required  ; 
but,  as  a  rule,  he  considers  that  mercury  in  small 
doses  acts  as  a  tonic,  lowering  the  temperature  and 
supporting  nutrition.  In  the  fever  accompanying 
the  syphilitic  cachexia,  and  which  shows  itself  at 
times  with  headache,  etc.,  DR.  DRAPER  uses  the 
specific  treatment  very  effectually;  the  usual  anti- 
pyretics, he  advises,  are  useless,  and  alcohol  only 
serves  to  make  matters  worse. 

The  following  combination  is  highly  esteemed  at 
the  NEW  YORK  HOSPITAL: 

];£.     Hydrarg.  biniodid.      .         .         .         gr.  i. 
Potass,  iodidi      .         .        .        .  3v. 

Syr.  aurant.  cort.         ...          §  ii. 
Tinct.  cardam.  co.  3  ii. 

Aquae  q.  s.  ad.  .        .         .         §  iv. 

M. 

At  ROOSEVELT  HOSPITAL  the  following  mixed 
treatment  is  employed : 

I-L    Hydrarg.  chlor.  corros.         .         .      gr.  ii. 

Potass,  iodidi       .         .         .  3vi. 

Syrup,  sarsap.  co.         * 

Aquae          .        .         .        .         .  aa  §ii. 
M. 


PART  II. 

DISEASES  OF  THE  AIR  PASSAGES. 


DIPHTHERIA. 

Contrary  to  the  opinion  of  many  specialists  in 
throat  diseases,  DR.  J.  LEWIS  SMITH  considers  diph- 
theria as  primarily  a  constitutional  disease.  He 
believes  that  when  the  larynx  is  involved,  the  affec- 
tion can  only  be  successfully  treated  by  solvent  in- 
halations, or,  if  they  fail,  by  tracheotomy.  As  a  rule, 
he  directs  that  the  child  be  placed  in  a  small  room 
which  is  rilled  with  steam,  and  the  croup  kettle  and 
steam  atomizer  set  to  work.  For  internal  medica- 
tion he  orders  the  following : 

]pfc.    Tinct.  ferri  chlor.       .         .         . 

Potass,  chlorat.  .         .         .    aa  3  ii« 

Syrupi §iv. 

•» 

M.  Sig.  A  teaspoonful  every  hour,  to  a  child  of 
five  years. 


DIPHTHERIA.  43 

Or  sometimes,  in  conjunction  with  the  above, 
the  following  is  also  given : 

P.    Quiniae  sulphat.  .        .        .          3  ss. 

Elix.  taraxaci  .         .  §  ii. 

M.    Sig.  A  teaspoonful  every  two  to  four  hours. 

Locally,  he  considers  lime  very  efficient,  although 
in  many  cases  the  progress  of  the  disease  is  too  rapid 
for  its  action.  From  experiments  made  in  the  New 
York  Foundling  Asylum,  he  has  found  that  a  two  per 
cent,  mixture  of  liquor  potassa  (or  liquor  sodce)  in 
water,  is  a  more  efficient  solvent  than  any  other 
agent  which  is  commonly  used  ;  and  with  this  dilu- 
tion it  does  not  cause  smarting  or  irritation  of  the 
healthy  buccal  or  faucial  surface.  It  is,  however, 
acrid  and  irritating  in  its  nature,  and  may  thus  act 
upon  those  parts  which  are  already  inflamed.  He 
therefore  uses  the  following : 

Ijfc.    Liquor  potassae  .         .         .  3  i. 

Aquae  calcis        ....        §  vii. 

M.  Sig.  To  be  used  almost  constantly,  by  the 
atomizer. 

By  this  means  the  liquor  potassae,  being  still  further 
diluted  by  the  steam  from  the  boiler,  reaches  the 
faucial  and  laryngeal  surfaces  in  the  proportion  of 
one  to  eighty-four.  In  some  cases,  he  has  used  in- 
halations of  lactic  acid  with  acidulated  liquid  pepsin, 


44  DIPHTHERIA. 

but  his  results  have  not  been  favorable ;  indeed,  he 
does  not  find  it  so  good  a  solvent  as  even  the  officinal 
lime  water,  and,  moreover,  the  atomizer  is  apt  to  be- 
come corroded. 

Stimulants  are  also  given.  When  diphtheria  com- 
plicates scarlet  fever,  DR.  SMITH  advises  that  more 
active  stimulation  is  demanded  than  when  the  dis- 
ease is  idiopathic.  He  usually  gives  brandy  in  doses 
of  3  i-  every  half  hour,  to  a  child  of  three  years  hav- 
ing these  two  infectious  maladies.  He  has  also,  in 
many  instances,  employed  the  antiseptic  treatment 
of  scarlatina  and  diphtheria  by  Listerine.  For  this 
purpose,  the  following  is  a  favorite  with  him,  pre- 
scribed together  with  the  old  remedies : 

]pfc.    Acid,  carbol.        ...  m.  viii, 

Liq.  ferri  subsulphat.  .         .    3  ii-iii. 

Glycerinae  .         .         .         .  §  i. 

M.  Sig.  Apply  to  the  throat  with  a  camel's-hair 
pencil,  two  or  three  times  a  day. 

For  paralysis  of  the  uvula,  which  is  a  very  fre- 
quent sequela  of  this  disease  in  children,  strychnia  is  his 
sheet-anchor.  For  administration,  he  prefers  the 
following  preparation,  3  i-  of  which  contains  gr.  -J^  of 
strychnia,  and  gives  it  thus : 

1$.    Elix.  phosphat.  ferri  et  strychniae         3  i- 
Aquae          .         .         .         .         .         3  iv. 

M.    Sig.  Dose,  three  times  daily. 


DIPHTHERIA.  45 

Under  this  treatment,  he  finds  that  in  the  majority 
of  instances  the'  paralysis  disappears  in  less  than  a 
week. 

DR.  A.  JACOBI  advises  that  the  strictest  attention 
should  be  paid  to  even  the  minutest  detail  of  treat- 
ment. He  believes  that  in  a  large  majority  of  the 
cases  of  diphtheria  which  terminate  fatally,  death 
occurs  because  of  mismanagement,  particularly  in  the 
worst  forms  of  the  disease;  and  where  a  case  of 
nasal  diphtheria  dies,  he  considers  it  usually  due  to 
insufficient  treatment  or  improper  management. 
Since  the  adoption  of  cleansing  and  disinfecting  in 
his  plan  of  treatment,  the  results  which  he  has  ob- 
tained have  greatly  improved.  He  finds  that  often 
when  there  is  a  slight  membrane,  but  with  an  enor- 
mous swelling  of  the  glands  below  and  behind  the 
angles  of  the  jaw,  a  sure  indication  of  nasal  diph- 
theria, showing  that  there  is  direct  poisoning  from 
that  locality,  if  immediate  resort  is  made  to  nasal  in- 
jections every  half  hour,  or  every  hour,  marked  im- 
provement follows,  and  he  not  infrequently  succeeds 
in  reducing  the  glandular  swellings  one-half  in  twelve 
hours. 

When  the  case  is  seen  at  the  early  stage  with  the 
tonsils  enlarged  and  covered  with  spots  of  membrane, 
DR.  JACOBI  often  prescribes  : 


46  DIPHTHERIA. 

9.    Potass,  chlorat.          .         .         .      gr.  ss-i. 
Tinct.  ferri  chlor.     .         .         .     gtt.  v-x. 
Glycerinae        .... 
Aquae       .         .         .         .     aa  q.  s.  ad  3  i. 

M.  Sig.  Dose,  every  twenty  minutes,  to  a  child 
of  three  to  five  years. 

In  addition  to  this,  if  the  glands  commence 
to  enlarge,  ice  is  applied.  He  considers  it  im- 
portant that  frequent  local  application  should 
be  made  to  the  parts,  and  by  giving  the  above 
mixture  in  this  way  (every  twenty  minutes),  the  in- 
fected tonsils  are  constantly  washed  with  the  potassa 
and  iron.  At  night  he  directs  that  the  medicine  be 
given  every  hour ;  this  does  not  interfere  with  rest,  as 
the  child  falls  asleep  almost  immediately  afterward. 

He,  moreover,  lays  particular  stress  upon  the  fact 
that  patients  are  left  alone,  often  at  dangerous  periods 
of  the  disease,  and  especially  cautions  against  per- 
mitting the  child  to  sleep  undisturbed,  a  constant 
tendency  caused  by  the  septic  poisoning.  Hence,  in 
these  dangerous  cases,  he  considers  it  highly  neces- 
sary to  effect  a  cure  in  thirty-six  or  forty-eight  hours, 
and  advises  that  the  child  must  not  be  allowed  to 
sleep  during  the  day  or  night,  longer  than  intervals 
between  the  times  of  using  the  injections  or  medi- 
cines prescribed  ;  that  is  to  say,  for  a  period  of  fif- 


DIPHTHERIA.  47 

teen  minutes  or  naif  an  hour.  Children  who  do  not 
give  much  trouble  die,  and  it  is  these  cases,  he  insists, 
that  must  be  thus  attended  to.  At  first  he  uses  the 
nasal  injections  every  half  hour  for  six  or  eight 
hours,  and  then  every  hour.  In  some,  however,  at 
the  commencement  he  finds  it  necessary  to  inject  the 
nose  every  half  hour,  and  to  continue  this  for  twenty- 
four  hours ;  after  which  once  an  hour  may  be  suffi- 
cient. Careful  attention  to  these  particulars,  he  ad- 
vises, will  often  result  in  favor  of  cure. 

Concerning  the  use  of  stimulants,  DR.  JACOBI 
finds  that  it  is  in  these  septic  cases  that  alcohol  is 
especially  indicated,  but  that  the  administration 
must  not  be  trifled  with  ;  from  §  "vi—viii.  to  ^  x—xii. 
of  brandy  must  be  given  in  the  twenty-four  hours. 
In  support  of  this  plan  he  mentions  a  case  in  which 
diphtheria  and  scarlatina  were  combined.  The  child, 
in  spite  of  moderate  treatment,  alcoholic  and  other, 
was  sinking  rapidly  and  almost  given  up  ;  but  when 
stimulants  in  large  amounts  of  §  viii-x.  were  admin- 
istered, a  rapid  recovery  followed. 

As  to  the  value  of  lime  water,  his  opinion  of  this 
agent  is  not  so  high  as  that  of  many  writers.  He 
believes  there  is  very  little  or  no  efficacy  in  it,  since 
in  the  amount  used  by  the  atomizer  there  is  hardly  a 
trace  of  lime ;  and  although  the  membrane  is  dis- 
solved by  maceration  in  lime  water  for  six  or  eight 


48  DIPHTHERIA. 

hours,  yet  he  thinks  this  action  can  hardly  be  claim- 
ed for  its  momentary  contact  with  the  throat. 

Regarding  the  internal  administration  si  potassium 
chlorate,  he  objects  to  the  long  continued  and  ex- 
tensive use  of  this  drug,  believing  that  when  given 
in  doses  exceeding  3  i-  in  amount  during  twenty-four 
hours,  to  a  child  of  less  than  three  years  of 
age,  nephritis  is  almost  certain  to  result.  Where, 
however,  catarrhal  stomatitis  is  also  present,  he  re- 
sorts to  potassium  chlorate  in  order  that  the  sur- 
rounding tissues  may  be  rendered  healthy.  Ben- 
zoate  of  sodiiim  he  considers  as  of  little  or  no  ser- 
vice. 

The  following  is,  however,  the  method  of  admin- 
istration according  to  the  Letzerich  treatment : 

9.    Sodii  benzoat.  pur.       .         .         .  3  i- 
Aquae  destill.          .... 

Aquae  menth.  pip.         .         .         .  aa  §  i. 

Syrup,  aurant.  cort.      .         .         .  3  ii- 

M.  Sig.  A  dessertspoonful  every  hour,  to  a 
child  under  one  year. 

His  opinion  of  the  utility  of  pilocarpine  is  also  un- 
favorable, and  in  those  cases  in  which  the  deposit  is 
deeply  imbedded  in  the  lower  structures,  he  believes 
it  does  positive  harm,  possibly  hastening  a  fatal  issue. 
If  the  drug  be  used  at  all  he  prefers  the  fluid  extract. 


DIPHTHERIA.  4y 

as  the  muriate  of  pilocarpine  is  decomposed  in  the 
stomach. 

In  regard  to  the  removal  of  tJie  membrane,  so  far 
as  the  tonsils  are  concerned,  DR.  JACOBI  objects  to 
this  interference ;  in  other  situations,  however,  he 
removes  the  false  membrane  when  possible  to  do  so. 
But  he  cautions  against  resorting  to  this  procedure 
injudiciously,  and  prefers  to  continue  the  injections 
and  washings  for  a  long  time,  rather  than  to  attempt 
the  removal  of  membrane  which  is  not  perfectly 
loose.  Finally,  in  all  cases,  he  urges  that  careful  at- 
tention to  nourishment  is  of  the  greatest  importance. 
He  directs  that  the  child  be  abundantly  fed  with  the 
most  nutritious  diet,  given  largely  every  hour  or  two, 
in  a  liquid  form  ;  and  that  life  be  sustained  by  stimu- 
lants and  nourishment  during  the  night  in  the  same 
manner.  By  this  means  he  believes  some  lives  may 
be  saved  that  would  otherwise  be  lost. 

In  the  treatment  of  the  sequela  of  diphtheria,  DR. 
JACOBI  advises  that  the  majority  of  cases  of  par- 
alysis run  a  benign  course,  and  get  well  in  eight  or 
ten  weeks.  His  treatment  is  in  the  main  tonic  and 
stimulant,  feeding  the  child  on  beef,  milk,  and  eggs, 
with  alcohol  in  small  quantities.  As  a  tonic  iron  is  pre- 
ferred, varying  the  preparation  according  to  the  case. 
If  diarrhoea  is  present,  he  uses  the  sulphate  of  iron 
most  beneficially.  For  a  nervine  he  considers  strych- 
4 


5O  DIPHTHERIA. 

nia  as  most  efficient  and  powerful  in  its  effects,  and 
gives  it  to  the  amount  of  gr.  J6  daily,  to  a  child  of 
four  years,  beginning  with  strychnia  sulph.gr.  -£•$  three 
times  a  day.  When  the  paralysis  is  extending,  and 
fear  is  entertained  that  the  respiratory  muscles  may 
become  involved,  he  resorts  to  the  galvanic  and  far a- 
dic  currents,  principally  the  latter,  and  administers 
hypodermic  injections  of  strychniae  in  doses  of  gr.  -gV 
once  or  twice,  or  several  times,  daily,  \vith  great  bene- 
fit. By  these  measures,  together  with  the  observance  of 
good  hygiene,  he  usually  effects  a  cure  in  most  cases. 

Where  the  disease  is  complicated  by  nephritis,  he 
orders  the  child  put  to  bed  and  administers  either 
the  hot  bath  or  hot  pack  twice  daily  to  produce  dia- 
phoresis. Or,  wrhere  the  heart's  action  is  good,  he 
sometimes  induces  a  free  perspiration  by  means  of 
hypodermic  injections  of  pilocarpine,  given  two  or 
three  times  in  the  twenty-four  hours  ;  and  in  addition 
to  this  alcohol  is  employed  to  counteract  the  depres- 
sion on  the  heart  caused  by  the  pilocarpine.  In  this 
way  he  occasionally  gives  as  many  as  eight  injections 
in  twenty-four  hours,  always  seeing  that  the  child  is 
well  stimulated  ;  this  extreme  resort  is,  however,  not 
advised  in  all  instances,  each  case  requiring  its  own 
special  treatment.  Sometimes  DR.  JACOBI  uses 
gallic  and  tannic  acid,  in  doses  of  gr.  v-xv.  daily,  in 
conjunction  with  the  pilocarpine,  and  often  with  very 


DIPHTHERIA.  $1 

favorable  action.  The  bowels  are  also  kept  gently 
open  by  means  of  the  cautious  administration  of  the 
salines.  Toward  the  later  stages  he  finds  iron  very 
serviceable  when  there  is  much  albumen  in  the  urine. 

DR.  C.  E.  BlLLlNGTON  considers  diphtheria  as 
primarily  a  local  affection,  and  that  its  specific  con- 
stitutional phenomena  are  secondary  results  by  ab- 
sorption. He  therefore  believes  local  antiseptic  treat- 
ment to  be  the  most  efficient  means  of  successfully 
combating  this  disease.  In  employing  this  treat- 
ment, however,  he  at  the  same  time  cautions  that 
the  danger  to  be  most  avoided  is  irritation  ;  this,  he 
advises,  may  render  the  method  unsuccessful  by  the 
evil  effects  which  it  causes.  To  remove  the  foul 
secretions  from  the  throat,  the  formulae  which  he 
habitually  uses  are  as  follows  : 

"$.    Potass,  chlorat 3ii. 

Glycerinae    .         .         .         .         .         ^  ss. 
Aq.  calcis     .....      5  n'ss- 

M.  Sig.  A  teaspoonful  every  half-hour,  to  a  child 
of  two  to  five  years. 

This  he  usually  administers  in  alternation  with 
the  following : 

ty.    Tinct.  ferri  chlor.  .         .          .          3i- 

Glycerinae     ..... 
Aquae    .         *         .         .         .  aa  §  5. 

M.    Sig.  A  teaspoonful  every  half-hour. 


52  DIPHTHERIA. 

Both  of  these  mixtures,  he  advises,  are  pleasant  to 
the  taste,  easily  taken,  and  cause  not  the  slightest 
irritation  to  the  parts.  In  some  cases  he  omits  the 
latter  with  advantage.  In  addition  to  these  meas- 
ures, he  also  sprays  the  throat  very  frequently,  when 
practicable,  and  for  some  minutes  by  means  of  the 
hand  atomizer,  using  the  following  solution  : 

]pL    Acid,  carbol  .....         m.  x. 
Aq.  calcis  .         .         .         .  §  iv. 

M.    Sig.  To  be  used  every  half-hour,  by  the  spray. 

Regarding  the  use  of  the  spray  of  carbolic  acid  and 
lime  water,  DR.  BlLLINGTON  considers  it  to  be  a 
remedy  of  great  value,  not  only  in  its  solvent  action 
on  the  false  membrane,  but  as  a  most  agreeable  and 
efficient  aid  in  subduing  inflammation.  He  also 
finds  it  one  of  the  most  reliable  means  for  efficiently 
applying  disinfectant  treatment  to  the  larnyx  ;  and 
in  his  experience  it  not  only  sometimes  cures,  but 
tends  to  prevent  laryngeal  diphtheria.  In  these 
laryngeal  cases  he  uses  it  as  nearly  constantly  as 
practicable.  The  careful  attention  to  all  these  de- 
tails cannot,  he  advises,  be  over-estimated.  Finally, 
except  in  bad  cases,  when  he  considers  this  first  in 
importance,  he  reaches  the  affected  surfaces  at  suit- 
able intervals  by  means  of  a  syringe,  using  a  weak, 
tepid  solution  of  common  salt.  This  he  throws 
through  the  open  mouth  into  the  throat,  or,  where 


DIPHTHERIA.  53 

the  nares  appear  to  be  invaded,  as  shown  by  a  dis- 
charge from  the  nose  or  by  obstructed  breathing, 
through  the  nostrils  into  the  nasal  passages  and  the 
pharynx ;  and  continues  the  process  until  the  foul 
secretions  are  thoroughly  washed  away  and  the  fetor 
is  corrected.  The  use  of  throat  and  nasal  syringing 
is  regarded  by  him  as  of  great  value,  and  he  believes, 
moreover,  that  not  a  few  cases  terminate  fatally 
where  these  measures  are  not  employed. 

Regarding  internal  medication,  in  the  treatment 
of  young  children  he  finds  it  very  important  that 
the  employment  of  any  unpleasant  medicines,  such 
as  quinine,  cubebs,  etc.,  should  be  particularly  avoided. 
As  to  the  administration  of  alcohol,  he  considers  it 
useful  in  the  later  stages  of  protracted  cases,  and 
during  convalescence.  The  prevalent  custom,  how- 
ever, of  a  free  and  early  resort  to  stimulants  he  be- 
lieves to  be  injurious,  and  it  is  his  experience  that 
they  often  add  to  the  poison  of  the  disease,  and  help 
to  overwhelm  rather  than  to  sustain  ;  therefore  in  a 
great  many  instances  he  has  treated  absolutely  with- 
out their  use.  In  all  cases,  DR.  BILLINGTON  insists 
upon  proper  nutrition  as  being  of  the  highest  im- 
portance. Milk  is  preferred  by  him,  given  freely  and 
often,  and  even  using  force  if  necessary ;  when  indi- 
cated, also,  he  advises  that  rectal  alimentation  should 
never  be  omitted. 


54  DIPHTHERIA. 

By  this  means  of  treatment,  carefully  and  judi- 
ciously carried  out,  and  with  the  strictest  regard  for 
every  minute  detail,  the  results  obtained  by  him 
have,  as  a  rule,  been  most  gratifying. 

DR.  A.  A.  SMITH  finds  that  potassium  cldorate  in 
doses  of  gr.  i  every  half-hour,  will  produce  the  same 
results  as  larger  doses,  and  without  the  danger  of 
evil  effects  ensuing  from  accumulation  of  the  drug 
in  the  system,  which  sometimas  happens  when  admin- 
istered in  the  ordinary  way.  Indeed,  he  believes  this 
method  will  give  more  beneficial  effect  on  the  throat 
inflammation.  On  this  plan  he  usually  prescribes : 

$.    Potass,  chlorat.        .         .         .         gr.  xvi. 
Aquae ^  ii. 

M.    Sig.  A  teaspoonful  every  half-hour. 

DR.  FRANCIS  DELAFIELD  considers  the  internal 
administration  of  alcolwl  and  the  use  of  iron  and 
potassium  chlorate  as  probably  the  best  means  of 
treatment.  He  gives  alcohol,  however,  not  merely 
for  sustaining  the  strength  of  the  patient,  but  for  its 
constitutional  effects  ;  hence  in  large  doses  and  in 
concentrated  form,  using  brandy  or  whiskey  in  doses 
of  3  /.  every  hour  or  tivo,  and  to  the  saturation  of 
the  system.  By  this  means  he  also  finds  that  the 
drug  acts  as  a  cardiac  stimulant  after  the  disease 
begins  to  improve.  He  advises,  moreover,  and  es- 
pecially in  severe  cases,  that  the  use  of  alcohol  must 


DIPHTHERIA.  55 

be  commenced  early.     The  iron  and  potassium  he 
gives  as  follows : 

IJ.    Tinct.  ferri  chlor.  .          .         gtt.  v-x. 

Sig.  Dose,  every  two  hours. 

This  is  alternated  with  : 

^.    Potass,  chlorat.  gr.  x-xv. 

Sig.  Dose,  every  two  hours. 

These  are  administered  so  that  the  child  gets  one 
every  hour.  The  use  of  soda  benzoate  in  large  doses 
of  gr.  x-xxx.  every  three  hours,  he  also  considers  an 
excellent  plan  of  treatment  in  many  cases. 

The  local  measures  adopted  by  him  consist  in  the 
application,  in  some  instances,  of  carbolic  or  salicylic 
acid  by  means  of  the  brush  or  spray ;  or,  in  others, 
of  the  tincture  of  the  chloride  of  iron.  This,  he  ad- 
vises, must  be  made  every  two  or  three  hours,  to 
obtain  good  effects.  Sprays,  steam  inhalations,  and 
vapor  of  lime,  are  also  used  at  times.  Where,  how- 
ever, the  larynx  is  involved  and  suffocation  is  immi- 
nent, tracheotomy  is  indicated,  although  he  finds  it 
even  less  satisfactory  than  in  croup. 

DR.  BEVERLY  ROBINSON  frequently  uses  lactic 
acid  in  the  form  of  a  spray  with  much  benefit.  The 
solution  he  employs  is  as  follows : 

II .    Acid,  lactic.  m.  xx. 

Aquae §  i. 

M. 


56  DIPHTHERIA. 

DR.  J.  H.  RlPLEY  considers  the  vapor  of  lime 
water  as  of  little  or  no  service,  since  the  patient  gets 
so  little  of  it.  He  has  used  it  in  the  form  of  the 
spray,  and  poured  it  by  teaspoonfuls  into  the  trachea, 
but  the  results  have  been  unfortunate. 

DR.  ALONZO  CLARK  uses  the  spray  of  lime  water 
as  frequently  and  as  constantly  as  indicated,  placing 
much  reliance  on  its  efficacy  when  thrown  upon  the 
forming  membrane. 

DR.  L.  ELSBERG,  has  found  bromine  to  be  a  much 
more  efficient  solvent  for  false  membrane,  than 
either  lime  water,  lactic  acid,  liquor  potassae,  or  liquor 
sodae  ;  and  if  properly  used,  he  finds  that  it  does  not 
cause  any  irritation.  For  this  purpose  he  prescribes 
the  following : 

Ijfc.    Brominii  .         .         .         .  gr.  i. 

Potass,  iodidi  .  .  3  i. 

Aquae  .         .  .         .    §  i. 

M.    Sig.  For  inhalation. 

* 
This,  he  advises,  can  be  poured  into  a  cone,  and  the 

child  be  permitted  to  inhale  the  fumes.  In  his  ex- 
perience this  solution  has  better  solvent  effect  on  the 
membrane  outside,  and  apparently  inside  also,  than 
either  of  the  above  agents. 

DR.  J.  R.  LEAMIXG  has  used  calomel  very  effect- 
ually in  many  instances.  This  drug,  however,  he 


DIPHTHERIA.  5.7 

administers  in  large    doses,  and  has  frequently  ob- 
tained the  best  results  in  a  very  few  hours. 

DR.  E.  C.  WENDT  has  prescribed  the  muriate  of 
pilocarpine  with  success  in  many  cases,  where  other 
remedies  had  been  tried  without  the  least  benefit. 
This  he  gives,  as  advocated  by  Guttman,  by  the  fol- 
lowing method,  which  has  been  found  most  advan- 
tageous : 

9.    Pilocarpin.  muriat.  .  gr.  ji-^i. 

Pepsin.  .  •  .  .  .  .  gr.  i-i^. 
Acid,  hydrochlor.  .  .  .  gtt.  ii. 
Aquse  destill.  ...  §  iiss. 

M.  Sig.  A  teaspoonful  every  hour,  to  a  ch?ld  of 
eight  or  ten  years. 

In  conjunction  with  the  above,  each  dose  is  fol- 
lowed by  teaspoonful  doses  of  old  sherry  wine.  By 
this  treatment,  kept  up  continuously  throughout  the 
night,  he  has,  in  many  severe  cases,  observed 
marked  improvement  in  a  very  short  time. 

*  The    ALCOHOL,   or    so    called    "  BROOKLYN," 
TREATMENT  of  diphtheria,  which  has  yielded  such 
excellent   results,  consists  in  the  administration  of 
alcohol,  not,  however,  as  in  a  variety  of  other  dis- 
eases, to  relieve  or  prevent  great  prostration,  but  for 
its  specific  action  as  an  antidote  to  the  diphtheritic 

*  The  Brooklyn  Treatment  of  Diphtheria  may  be  considered 
as  of  sufficient  importance  to  entitle  it  to  an  insertion  here. 


58  DIPHTHERIA. 

poison.  In  these  cases  its  stimulant  or  other  ordi- 
nary effects  are  not  induced  by  it,  and  intoxication 
has  never  been  observed,  while  enormous  doses  have 
been  administered  to  young  children.  Not  only, 
moreover,  as  an  antidote,  but  also  as  a  prophylactic 
of  diphtheria  is  the  value  of  alcohol  demonstrated, 
when  administered  early  and  in  sufficient  doses.  For 
this  latter  effect  the  following  prescription  is  very 
generally  employed  : 

5&.    Cinchon.  sulph.  .         .         .          3  i- 

Acid,  sulph.  aromat.  .  .  .  q.  s. 
Spts.  vini  gall.  ....  3  vii. 
Glycerin,  opt.  .  .  .  .  §  i. 

M.  Sig.  From  a  small  teaspoonful  to  a  table- 
spoonful  every  two  hours,  according  to  age. 

And  even  to  prevent  or  cut  short  any  of  the  se- 
quelae, it  is  claimed  for  this  plan  of  treatment  that 
there  is  no  remedy  so  reliable  as  alcohol.  In  the 
majority  of  instances  quinine  is  also  administered, 
although  in  many  cases  alcohol  alone  is  employed, 
and  the  effect  seems  to  be  almost  as  decided  and 
quick  without,  as  with,  quinine.  Where  the  medicine 
is  refused  on  account  of  the  taste  of  the  drug,  the 
alcohol  is  often  given  separately,  and  the  quinine 
administered  by  inunction,  as  follows  : 

];£.    Quiniae  sulph.  . 

Cliloroformi 


DIPHTHERIA.  59 

Bals.  peruv aa  3  ss. 

Adipis          .        .         .        .  3vi. 

M. 

For  the  alcohol,  the  following  formula  is  usually 
employed : 

I-fc.    Spts.  vim  gall.  .         .         .          §  iiss. 

Glycerinae  opt.     .... 
Syrupi  simp.    .         .         .  aa  §  ss. 

Aquae  menth.  pip.  q.  s.  ad    .         .       §  iv. 
M.    Sig.     A   teaspoonful  every  hour,  to  a  child 
under  two  years.     From   two  to  three  years,  3  iss., 
from  three  to  five  vears,  3  ii.»  and  from  five  to  eight 
years,  3  iiss—  ^  ss.  every  hour. 

Or,  in  many  instances  the  following  combination 
may  be  used  very  satisfactorily: 

^fc.     Quiniae  sulph.         .         .         .          gr.  xvi. 
Acid,  sulph.  aromat.  .         .          q.  s. 

Spts.  vini  gall.        .  .     §  iss. 

Syrup,  simp,  ad  ...          §  ii. 

M.    Sig.     A  teaspoonful  every  two  hours. 
In  addition  to  the  above,  whiskey  may  be  given  in 
doses  of  3  i-iii.  as  indicated.     Champagne  is  also  used 
in  many  severe  cases. 

The  local  measures  resorted  to  consist  in  the  ap- 
plication of  a  light  astringent,  either  in  the  form  of 
a  gargle  or  spray,  or  as  a  powder  to  be  blown  directly 
on  the  diseased  parts  ;  chlorate  of  potassium,  powdered 


60  CORYZA. 

alum,  and  tannic  acid,  either  combined  or  otherwise, 
with  the  addition  of  a  comparatively  large  quantity 
of  carbolic  acid,  being  used  for  this  purpose. 

Besides  these  means  of  treatment,  great  impor- 
tance is  always  attached  to  hygiene ;  cleanliness  and 
fresh  air  commanding  primary  attention.  In  regard  to 
nourishment,  during  the  first  twenty-four  hours  of 
an  attack  little  or  none  at  all  is  given,  as  a  rule,  but 
in  all  cases  the  first  food  administered  consists  of 
milk  and  lime  water,  with  the  addition  of  a  Tittle 
salt.  During  convalescence  iron,  particularly  dia- 
lysed  iron,  is  employed,  and,  in  combination  with  some 
form  of  alcohol,  either  prevents  or  relieves  the  con- 
ditions of  anaemia  and  loss  of  nerve  power  which 
are  so  apt  to  follow  diphtheria. 


CORYZA. 


In  acute  cases,  where  the  attack  is  of  a  mild  char- 
acter, Dr.  J.  LEWIS  SMITH  advises  that  very  little 
treatment  is  required.  He  directs  that  the  bowels  be 
kept  open,  the  feet  soaked  in  mustard  water,  and  the 
body  warmly  clothed.  Inunction  of  the  nostrils  is 
also  resorted  to,  and  often  with  much  relief.  Where 


CORYZAf  6 1 

there  are  evidences  of  the  extension  of  the  disease 
toward  the  bronchial  tubes,  he  gives  an  emetic  of 
syrup  of  ipecac,  followed  by : 

9-    Syrupi  ipecac.         .         .         .  3  ii- 

Spts.  aether,  nitr 3  i. 

Syrupi  simp §  ii. 

M.  Sig.  A  teaspoonful  every  three  hours,  to  a 
child  of  six  months. 

He  further  employs  injections  very  beneficially.  A 
three  to  five  per  cent,  solution  of  common  salt  in  warm 
water  is  used,  injecting  it  into  the  nostrils  with  a 
small  syringe.  This  aids  materially  in  removing  the 
muco-pus  which  obstructs  the  respiration,  and  in 
establishing  a  healthful  state  of  the  inflamed  surface. 
Or,  sometimes  a  mixture  of  carbolic  acid,  glycerine 
and  water,  with  a  few  grains  of  potassium  chlorate 
added,  is  used  instead  of  salt. 

Chronic  cases  of  coryza,  or  "  snuffles,"  are  usually 
attributed  to  the  strumous  cachexia,  and  often  asso- 
ciated with  glandular  enlargements,  etc.  For  local 
measures,  in  these  patients,  DR.  SMITH  treats  by 
injecting  into  the  nostrils  with  a  glass,  or  hard  rubber, 
or  rubber  ball,  syringe,  a  solution  of  equal  parts  of 
lime  water  and  warm  water,  at  a  temperature  of  about 
100°,  the  child  being  placed  on  the  back  with  a  towel 
laid  over  the  eyes.  Internally  he  gives  the  follow- 
ing: 


62  CORYZA. 

]pL    Olei  morrhuae  .         .         .  ^\\. 

Syrupi  ferri  iodidi     ...  3  i- 

M.  Sig.  A  teaspoonful  three  or  four  times  daily, 
to  a  child  of  one  year. 

If  constipation  is  present,  which  is  frequently  the 
case,  he  finds  this  doubly  serviceable,  since  the  cod 
liver  oil  will  also  act  as  a  laxative  besides  its  effect  on 
nutrition.  In  addition,  and  especially  in  chronic  cases 
associated  with  syphilis,  he  considers  the  following  an 
excellent  application  to  parts  which  can  be  reached 
by  a  camel's-hair  pencil,  or  with  a  nasal  sponge  : 

^.    Ung.  hydrarg.  nitrat.         .         .         .   3  ii- 
Ung.  zinci  oxidi.         .         .         .  §  ii. 

M.  Sig.  Apply  three  or  four  times  daily,  as  far 
within  the  nostrils  as  possible. 

Where  the  child  is  anaemic,  he  further  advises  that 
a  teaspoonful  of  the  juice  expressed  from  rare  beef- 
steak be  given  every  two  hours. 

Dr.  A.  A.  SMITH  often  uses  aconite  very  bene- 
ficially. In  many  cases  seen  at  the  commencement, 
with  more  or  less  fever,  and  where  the  skin  is  hot 
and  dry,  the  pulse  full  and  bounding,  and  the  mu- 
cous membrane  of  the  throat  and  nostrils  dry,  he 
gives  the  following  with  decided  benefit : 

Ijfc.    Tinct.  aconit.  rad.         .         .       m.  ^->^. 
Aquae  q.  s. 

M.     Sig.  Dose,  every  fifteen  minutes. 


TRUE   CROUP.  63 

When  perspiration  appears,  which  usually  occurs 
in  a  short  time  afterward,  he  then  administers  the 
drug  at  longer  intervals  ;  every  half-hour  or  longer, 
according  to  indications. 

In  older  children,  the  following  is  recommended 
very  highly  by  DR.  J.  R.  LEAMING,  as  a  means  of 
aborting  a  cold  if  taken  early : 
$.    Ammon.  chlorid. 

Potass,  nitrat 

Senegae aa^ss. 

Glycyrrhizae  .         .         .         .         §  i. 

Aquae Qi- 

M.     Sig.  3  ii  to  §  ss.  every  half-hour. 


TRUE  CROUP. 

(ACUTE  CROUPOUS  LARYNGITIS.) 

In  the  treatment  of  this  disease,  Dr.  J.  H.  RIPLEY 
considers  the  use  of  medicinal  measures  exceedingly 
unsatisfactory.  The  only  rational  plan,  in  his  ex- 
perience, is  a  symptomatic  one.  Stimulants  and  extra 
feeding  are,  however,  required  in  severe  cases.  If 
seen  in  the  early  stage  before  serious  dyspnoea  is  pres- 


64  TRUE  CROUP. 

ent,  he  at  once  applies  a  large  warm  poultice  over  the 
larynx  and  extending  nearly  down  to  the  root  of  the 
neck  ;  it  is  also  made  to  fit  as  closely  as  possible 
without  obstructing  the  circulation  or  respiration, 
and  changed  as  soon  as  it  becomes  cool.  This,  he 
finds,  not  only  affords  comfort  but  in  many  cases 
gives,  at  least,  temporary  relief.  The  temperature  of 
the  room  is  kept  at  70°  or  80°,  and  the  air  constantly 
moistened  with  steam.  In  addition,  if  possible,  he 
also  secures  direct  application  of  steam  by  means  of 
the  croup-kettle,  using  it  five  minutes  at  a  time  at 
intervals  of  fifteen  minutes,  and  finds  that  it  often 
renders  most  valuable  service.  While  the  child  is 
sleeping,  a  gentle  stream,  not  too  warm,  may  also  be 
kept  up  continually.  As  regards  lime  water,  he  does 
not  find  it  any  more  serviceable  than  steam,  whether 
produced  from  slaking  lime,  or  thrown  by  means 
of  the  spray.  The  spray  is,  however,  used  in  many 
cases,  and  the  atmosphere  saturated  with  lime  steam 
by  means  of  kettles  filled  with  a  mixture  of  quick- 
lime and  water,  and  kept  boiling. 

Concerning  emetics,  DR.  RlPLEY  prefers  either  the 
sulphate  of  copper  or  the  yellow  sulphate  of  mercury, 
as  most  prompt  and  efficacious.  In  using  them  he 
tries  the  drug  once  or  twice,  but  no  more,  as  he  de- 
cidedly objects  to  the  repeated  exhibition  of  these 
depressing  agents,  thus  exhausting  the  patient.  In 


TRUE   CROUP.  .        65 

addition  to  the  above  means  of  treatment,  as  a  rule, 
he  prescribes  the  following  : 

^.    Potass,  chlorat gr.  v. 

Tinct.  ferri  muriat.      .         .         .      gtt.  v. 

Syrupi  

Aquae         .  .  aa  q.  s. 

M.  Sig.  Dose,  every  two  hours,  to  a  child  of  one 
to  five  years. 

This  is,  in  many  instances,  continued  throughout 
the  whole  course  of  the  disease.  Should  diarrhoea 
result  from  its  use,  as  sometimes  happens,  the  admin- 
istration is  stopped  and,  if  required,  an  emetic  is 
given.  Stimulants,  brandy  and  milk,  are  also  used 
as  indicated.  Where  there  exists  a  previous  history 
of  malaria,  and  with  high  temperature,  quinine  is  or- 
dered ;  in  some  instances  giving  ; 

~fy.      Quiniae  sulph.  gr.  xx. 

Sig.    This   amount  during  the  twenty-four 
hours,  to  a  child  of  two  or  three  years. 

Or,  in  others,  gr.  v.  is  administered,  and  the  dose 
repeated  in  one  or  two  hours.  In  older  children 
gr.  x.  may  be  given  at  night,  followed  by  gr.  v.  in 
the  morning,  and  this  amount  increased  as  de- 
manded. 

Sometimes,  instead  of  the  potassium  chlorate  and 
iron  solution,  he  finds  bromine  very  serviceable, 
thus: 

5 


66  TRUE   CROUP. 

9.    Brominii      .         .         .         .         .         3ss. 
Aq.  cinnamomi §  iv. 

M.  Sig.  A  teaspoonful  every  two  hours,  taken  in 
milk. 

This  may  also  alternate  with  stimulants  in  the 
form  of  milk  punch.  He  advises,  however,  that  the 
bromine  often  causes  marked  gastric  irritation,  and 
cannot  be  continued  with  regularity.  If  the  case  is 
seen  early  and  patches  are  discovered  on  the  tonsils, 
he  sometimes  cauterizes  them  with  a  solution  of 
silver  nitrate,  and  prescribes  bromine  internally,  as 
above. 

When,  however,  all  these  measures  are  unavailing, 
and  medicinal  treatment  has  failed  either  to  relieve 
or  to  check  the  progress  of  the  disease,  and  with 
exhaustion  and  cyanosis  approaching,  DR.  RIPLEY 
immediately  resorts  to  tracheotomy.  In  such  a  case 
the  after  treatment,  he  advises,  requires  the  utmost 
care  and  attention.  The  child  should  be  seen  every 
eight  hours,  for  the  first  few  days  following  the 
operation.  Usually  during  the  first  twenty-four 
hours  nothing  unfavorable  occurs.  If  the  breathing 
is  perfectly  free,  he  fastens  a  large  moist  sponge  over 
the  mouth  of  the  tube,  which  accomplishes  the  two- 
fold purpose  of  warming  and  of  moistening  the  air, 
and  can  easily  be  kept  clean,  while  it  also  allows  of 
a  ready  manipulation  of  the  tubes.  Should  the 


TRUE  CROUP.  67 

breathing  be  at  all  harsh,  he  directs  that  the  inhal- 
ation of  steam  from  the  croup-kettle  be  continued. 
Also,  in  any  case,  he  finds  that  it  is  usually  best  to 
keep  the  air  of  the  room  moist,  and  at  a  temperature 
of  70°  or  80°.  The  inner  tube  is  taken  out  and 
cleaned  as  often  as  it  becomes  obstructed  ;  but,  on 
the  second  day,  as  a  rule,  he  removes  both  tubes, 
cleaning  them  thoroughly  and  applying  new  tapes  ; 
while  at  the  same  time,  also,  the  wound  is  cleaned, 
and  the  larynx  examined  as  to  its  permeability. 
When  returning  the  tube,  he  usually  places  a  washer, 
formed  of  several  folds  of  muslin,  or  other  material, 
and  smeared  with  a  mild  ointment,  between  the 
plate  and  wound,  thus  affording  much  comfort  to 
the  patient.  The  tube  is  permanently  removed  as 
soon  as  respiration  can  be  carried  on  through  the 
larynx. 

DR.  J.  R.   LEAMING  recommends   the  following 
as  often  rendering  excellent  service  : 

]jfc.    Potass,  chlorat.    .         .         .         .          3  ii- 

Ammon.  chlorid 3  i. 

Aquae  cinnamom.        .         .         .         §  iii. 
Syrup,  senegae        .         .         .  §  ss. 

Spts.  aether,  nitros.     .         .         .          §  ss. 
Ext.  glycyrrh 3  iss. 

M.    Sig.  A  teaspoonful  to  a  tablespoonful,  accord- 
ing to  age,  every  two  hours. 


68  TRUE  CROUP. 

He  also  combines  iron  with  the  above,  when  re- 
quired, according  to  indications. 

DR.  J.  LEWIS  SMITH  directs  that  the  atmosphere 
of  the  room  in  which  the  child  is  placed,  be  con- 
stantly loaded  with  moisture,  thus  rendering  the 
cough  looser  and  promoting  expectoration.  Any 
degree  of  heat,  however,  which  would  add  materially 
to  the  discomfort  of  the  patient,  must  be  avoided. 
A  temperature  of  75°  to  80°  is  usually  required. 
The  following  is,  in  his  experience,  the  most  efficient 
solvent  for  the  false  membrane,  and  should  be  used 
almost  constantly,  by  means  of  the  atomizer : 

Ipfc.    Liq.  sodae  (or  potassae)          .         .          3  i. 
Aquas  calcis       ....          §  vii. 

M. 

This  is  freely  sent  directly  to  the  inflamed  surface 
in  the  form  of  a  spray. 

For  internal  treatment,  an  emetic  is  first  adminis- 
tered, for  which  purpose,  as  a  rule,  he  prefers  the 
yellow  sulphate  of  mercury,  in  powder,  in  doses  of 
gr.  ii.  In  addition  to  this,  he  prescribes  the  follow- 
ing mixture  with  much  benefit : 

]£.    Potass,  chlorat.          . 

Ammon.  muriat.  .         .         aa  3  i-H- 

Syrup,  simp §  i. 

Aquae §  iii. 

M.    Sig.  A  teaspoonful  every  hour. 


TRUE   CROUP.  69 

As  regards  local  measures,  DR.  SMITH  employs 
cold  water,  especially  in  the  early  stages,  preferring 
this  measure,  in  most  cases,  to  the  use  of  poultices. 
This  may  be  dropped  constantly  from  a  sponge, 
upon  a  compress  laid  over  the  throat  of  the  child ; 
or,  two  or  three  thicknesses  of  muslin  soaked  with 
camphorated  oil,  are  applied  over  the  larynx,  so  as 
to  cover  the  neck  in  front,  and  over  this  is  placed  a 
bladder  containing  pieces  of  ice,  or  ice  surrounded 
by  oil-silk.  If  dyspnoea  becomes  severe,  the  inhala- 
tion of  oxygen  is  often  found  of  great  service.  As  to 
the  advisability  of  tracheotomy,  he  considers  this 
resort,  when  indicated,  proper  and  justifiable,  and 
advises  that  it  should  not  be  delayed. 

To  control  the  inflammation  DR.  FRANCIS  DELA- 
FIELD  employs  leeches,  in  strong,  healthy  children, 
applied  over  the  region  of  the  larynx  ;  and  following 
this  measure  with  hot  or  cold  applications  around 
the  throat,  either  ice-bags,  or  sponges  wrung  out  of 
hot  or  cold  water.  The  child  is  also  made  to  breathe 
vapor  of  some  kind,  either  hydrating  lime,  or  hot  or 
medicated  water ;  or  the  room  is  filled  with  steam, 
or  the  steam  tent  used.  For  .internal  medication,  at 
the  commencement  he  gives  an  emetic,  usually 
antimony  in  small  doses,  combined  with  a  small 
amount  of  opium.  Regarding  the  administration  of 
calomel  to  the  point  of  salivation,  he  discountenances 


/O  TRUE  CROUP. 

this  practice  ,  but  advises  that  if  given  in  small 
doses  until  the  bowels  move,  and  then  discontinued, 
much  benefit  is  often  derived  from  its  use.  On  this 
plan  he  prescribes : 

5,.     Hydrarg.  chlor.  mit.        .         .         gr.  ss-i. 
Sig.  Dose,  every  one  or  two  hours. 

For  the  restlessness,  small  doses  of  opium  in  some 
form  are  given.  When  signs  of  insufficient  aeration 
of  blood  are  present,  the  inhalation  of  oxygen  is  em- 
ployed, affording  great  relief.  If,  however,  the  dis- 
ease is  so  far  advanced  that  the  breathing  is  ob- 
structed, he  resorts  to  tracheotomy.  In  regard  to 
this  procedure,  DR.  DELAFIELD  advises  that  if  the 
operation  is  performed  while  the  local  inflammation 
is  running  its  course,  the  chances  of  recovery  are 
much  greater.  Therefore,  in  cases  where  the  bronchi 
are  not  involved,  as  soon  as  it  is  evident  that  the 
disease  is  not  yielding,  and  deficient  aeration  is 
prominent,  he  operates  at  once,  with  considerable 
hope  of  this  resort  being  not  only  beneficial  but 
successful. 

If  seen  at  the  onset  of  the  disease,  DR.  A.  HAD- 
DEN  usually  administers  a  dose  of  castor  oil,  suffi- 
cient to  move  the  bowels.  He  then  places  a  napkin 
wrung  out  of  cold  water  about  the  neck,  directs  that 
the  child  be  confined  to  bed,  and  prescribes  the  fol- 
lowing : 


TRUE  CROUP.  71 

]p&.    Tinct.  ferri  chlor. 

Sodae  chlor.  .         .         .  aa  3  i- 

Glycerinae  .         .        .        .         §  ss. 

Aquae  pur.      ....  §  'l'lss- 

M.  Sig.  A  teaspoonful  every  hour,  to  a  child  of 
three  to  six  years. 

In  many  cases,  where  the  false  membrane  is  con- 
fined to  the  tonsils,  he  applies  the  following  astrin- 
gent mixture  to  the  affected  parts,  finding  it  of  great 
value,  and  particularly  so  when  the  membrane  does 
not  extend  to  the  larynx : 

IjL    Liq.  ferri  sulphatis       .         .         .         3  i- 
Glycerinae §  i. 

M.  Sig.  To  be  applied  repeatedly,  by  means  of 
the  throat  brush. 

Should  the  appearance  of  the  membrane  increase 
and  with  a  tendency  to  spread,  he  often  uses  the  fol- 
lowing with  good  effect : 

^.    Potass,  chlorat 3  "• 

Aquae Oi. 

M.    Sig.     Gargle. 

When,  however,  the  croupy  condition  becomes 
more  manifest,  with  hoarseness,  etc.,  he  directs  that 
the  temperature  of  the  room  be  maintained  at  70°  to 
80°,  and  the  air  kept  constantly  moist  with  steam. 
Lime  is  also  slaked  in  the  apartment  so  that  the  pa- 
tient can  breathe  the  fumes  ;  this  is  found  to  have  a 


72  TRUE   CROUP. 

very  soothing  effect,  and  constitutes  a  means  of  re- 
lief upon  which  DR.  HADDEN  places  great  reliance. 
In  addition  to  these  measures  he  frequently  pre- 
scribes bromine,  to  be  taken  internally,  with  much 
benefit.  In  some  instances  turpeth  mineral  is  given, 
as  an  emetic  and  for  its  alterative  action.  If  the 
symptoms  increase  in  severity,  in  spite  of  these  means 
of  treatment,  and  the  croupy  cough  continues,  he 
often  finds  the  application  of  a  strong  solution  of 
silver  nitrate,  by  means  of  a  probang,  very  service- 
able in  lessening  the  symptoms  and  checking  the  ex- 
udation. 

If,  however,  all  endeavors  are  unavailing  and 
the  case  still  progresses  unfavorably,  he  resorts  to 
tracheotomy.  Regarding  this  procedure,  he  believes 
that  the  operation,  when  indicated,  is  not  only  prac- 
ticable but  imperative,  and  in  many  cases  the  only 
expedient  that  can  hold  out  the  least  hope  of  saving 
life.  And  in  all  cases  he  operates  as  soon  as  suffo- 
cation threatens,  and  it  is  evident  that  medicinal 
measures  are  not  likely  to  afford  relief.  After  the 
canula  is  in  position,  DR.  HADDEN  also  considers  it 
a  very  essential  part  of  the  treatment,  to  make  ap- 
plications through  the  tube,  by  means  of  a  soft 
feather,  of  the  above  solution  of  iron  and  glycerine, 
to  the  inner  surface  of  the  trachea.  This  he  repeats 
as  frequently  as  every  two  or  three  hours  during  the 


TRUE   CROUP.  73 

day,  and  believes  the  success  following  the  operation 
to  be,  in  a  great  measure,  dependent  upon  this  pro- 
cedure. 

DR.  A.  L.  LOOM  IS  directs  that  the  child  be  placed 
in  a  large  room,  the  air  of  which  is  kept  moistened, 
and  the  temperature  at  about  76°;  this  he  considers 
to  be  of  the  highest  importance.  In  many  instances 
the  tent  is  used,  and  steam  from  boiling  molasses  and 
water  carried  into  it.  Lime  vapor  is  also  used  with 
good  effect.  If  seen  at  the  onset,  before  the  for, 
mation  of  any  false  membrane,  he  often  derives 
much  benefit  from  the  administration  of  quinine  in 
large  doses,  with  the  object  of  aborting  the  laryngeal 
inflammation,  or  preventing  its  assuming  a  croupous 
form.  For  this  purpose  he  usually  prescribes  : 

]jl.     Quiniae  sulph.         .         .         .         gr.xxx. 

Sig.  gr.  v.  every  four  hours,  for  twenty-four 
hours,  to  a  child  of  three  years. 

When  the  false  membrane  is  present,  however,  in- 
halation constitutes  his  sole  reliance  for  safety. 
Should  signs  of  imperfect  aeration  appear,  oxygen  is 
often  of  great  service  ;  a  stream  being  passed  into 
the  tent,  or  direct  inhalation  employed.  In  addition 
to  these  measures,  hot  cloths  or  sponges,  squeezed 
dry  (from  boiling  water),  are  continuously  applied  to 
the  neck.  For  an  emetic,  when  indicated,  he  prefers 
zinc  sulphate.  Direct  local  applications,  he  advises, 


74  SPURIOUS   OR   CATARRHAL   CROUP. 

do  more  harm  than  good.  He  has  also  very  little 
faith  in  the  various  specifics  used  in  this  disease.  Re- 
garding diet,  this  is  made  of  the  most  nutritious 
character  throughout,  and  when  called  for  stimulants 
are  freely  given  to  sustain  the  vital  powers. 

Finally,  DR.  LOOMIS  advises  that  the  resort  to 
tracheotomy,  to  be  of  service,  must  be  made  early, 
if  at  all ;  and  not,  as  is  so  often  the  case,  after  the 
child  has  passed  beyond  all  hopes  of  recovery. 

DR.  AUSTIN  FLINT  believes  that  the  operation  of 
tracheotomy  is  not  only  justifiable,  but  that  it  is  a 
duty  which  should,  if  possible,  be  performed,  when- 
ever it  is  evident  that  the  child  is  dying  from  suffo- 
cation. 


SPURIOUS  OR  CATARRHAL  CROUP. 
(ACUTE  CATARRHAL  LARYNGITIS.) 


DR.  J.  LEWIS  SMITH  finds  that  most  cases  do  well 
under  suitable  hygienic  treatment,  and  without  the 
use  of  any  medicines  whatever.  He  uses  demulcent 
drinks,  however,  with  much  benefit,  together  with  an 
occasional  laxative.  To  relieve  the  cough,  when 


SPURIOUS   OR  CATARRHAL  CROUP.  75 

troublesome,  he  uses  a  mixture  of  paregoric  and 
syrup  of  ipecac,  with  marked  benefit.  Or,  he  some- 
times finds  a  small  Dover  s  powder  fulfills  this  indica- 
tion very  effectually.  For  the  restlessness  a  warm 
mustard  foot-bath  usually  affords  relief.  Inhalations 
of  a  spray  of  glycerine  and  water  are  also  used  by 
him  with  good  effect,  together  with  mild  applica- 
tions, such  as  camphorated  oil,  rubbed  over  the  part 
several  times  daily. 

DR.  FRANCIS  DELAFIELD  advises  against  any 
unnecessary  alarm,  thereby  causing  the  child  to  be 
treated  much  more  energetically  than  necessary. 
Mild  cases,  he  finds,  may  require  little  or  no  treat- 
ment at  all.  To  increase  the  secretion  of  mucus, 
and  thus  relieve  the  stridulous  cough  and  breathing, 
he  administers  tartar  emetic  in  small  and  frequently 
repeated  doses,  thus : 

3jL    Vini  antimonii  .         .         .  gtt.  v-x. 

Sig.  Dose,  according   to   age,  every  one   to 
three  hours. 

If  this  amount  causes  vomiting,  he  directs  that  the 
drug  must  not  be  discontinued,  but  the  dose  dimin- 
ished to  gtt.  v.  ;  and  if  emesis  is  still  produced, 
he  then  reduces  this  to  gtt.  ii-iii.,  or  until  he  ascer- 
tains what  amount  the  patient  can  take  without 
vomiting.  For  the  restlessness,  one  of  the  opium 
preparations  is  given  in  small  doses ;  using  either 


76  SPURIOUS   OR   CATARRHAL   CROUP. 

Dover's  powder,  paregoric,  or  laudanum,  or  he  often 
finds  the  syrup  of  poppies  very  serviceable.  To 
relieve  the  dyspnoea,  especially  in  spasmodic  attacks, 
if  it  is  very  severe  and  the  fever  high,  he  gives  an 
active  emetic,  either  of  the  following  being  preferred 
for  this  purpose  : 

IJ.     Hydrarg.  sulph.  flav.  .         gr.  iii-v. 

$.     Vini  antimonii  .        .         .          3i- 

IjL  Vini  ipecac.  .  .  .  .  3  i- 
In  severe  cases  of  dyspnoea,  tracheotomy  is  indi- 
cated, and  is,  he  finds,  sometimes  the  only  relief. 
In  regard  to  this  resort,  DR.  DELAFIELD  advises  not 
to  delay  too  long ;  after  one  or  two  severe  attacks 
the  third  should  not  be  waited  for,  as  it  may  prove 
fatal.  In  those  cases  where  the  disease  is  pro- 
tracted, or  evinces  a  tendency  to  become  so,  lasting 
from  ten  days  to  two  weeks,  he  considers  the 
administration  of  a  brisk  purge,  followed  by  tonics 
aftenvard,  as  the  best  means  of  breaking  up  the  dis- 
ease. On  this  principle,  he  gives  calomel  every  hour 
until  the  bowels  move,  up  to  gr.  v.  being  usually  suf- 
ficient ;  after  which,  he  stops  the  calomel  and  admin- 
isters quinine  in  doses  of  gr.  i-i.  By  this  means, 
satisfactory  results  generally  follow. 

DR.  A.  L.  LOOMIS  considers  rest  to  the  part  of 
primary  importance.  He  directs  that  the  patient  be 
confined  in  a  warm  room,  the  air  of  which  is  kept 


SPURIOUS   OR   CATARRHAL   CROUP.  // 

moist  by  steam,  and  the  temperature  at  about  758. 
Where  there  is  very  little  or  no  induration  present, 
he  finds  that  the  persistent  use  of  inhalations  of 
vapor  are  of  the  greatest  service,  and  believes  this 
measure  to  be  far  superior  to  any  other  local  means 
of  treatment.  He  objects  to  the  use  of  antimony  or 
calomel,  as  well  as  to  the  application  of  blisters  or 
leeches.  For  internal  medication,  he  resorts  to  the 
early  administration  of  quinine  in  large  doses,  with  a 
view  to  rapidly  producing  the  effects  of  the  drug. 
On  this  plan,  especially  if  begun  at  the  outset,  he 
has  frequently  succeeded  not  only  in  controlling  but 
in  arresting  the  progress  of  the  disease.  This,  in  a 
severe  case,  he  usually  gives  as  follows  : 

IJ,.     Quiniae  sulph.  gr.  xx. 

Sig.  This  amount  during   the    first   twenty- 
four  hours,  to  a  child  of  three  years. 

Should  these  means  fail  and  oedema  come  on, 
scarification  is  practiced.  When,  however,  this  can- 
not be  done,  or  is  useless,  and  suffocation  is  evident, 
he  resorts  to  tracheotomy ;  advising,  moreover, 
against  too  great  a  delay  in  this  respect. 


78  LARYNGISMUS   STR1DULUS. 

LARYNGISMUS  STRIDULUS. 

(SPASMODIC  CROUP.) 


In  ordinary  cases,  to  relieve  the  spasm,  DR.  J. 
LEWIS  SMITH  places  the  child  in  a  warm  bath,  of  a 
temperature  of  100°,  as  soon  as  possible  after  the 
onset  of  the  attack.  The  bath  is  continued  for  ten 
or  fifteen  minutes,  after  which  he  administers  an 
emetic,  as  follows : 

Ijfc.    Syrup,  ipecac 3  i. 

Sig.  Dose,  to  a  child  under  three  years. 

This  is  repeated  in  twenty  minutes,  or  until  vomit- 
ing occurs.  Or,  in  the  majority  of  cases,  he  finds  the 
following  combination  more  prompt  in  action  than 
ipecac  alone  : 

IjL    Aluminis 3  ii- 

Syrup,  ipecac §  i. 

M.  Sig.  A  teaspoonful. 

In  children  over  three  years  of  age,  he  considers 
the  syrup,  scillce  co.  in  doses  of  '.3  i  as  having  the  best 
effect ;  one  or  two  doses  being  usually  sufficient  for 
this  purpose.  In  addition  to  these  means  of  treat- 
ment, if  the  bowels  are  not  already  loose,  a  purge  is 
administered.  Inhalations  of  steam  are  also  used, 
and  often  the  application  of  a  sinapism  over  the  neck 
is  followed  by  marked  benefit.  Where  the  nervous 


LARYNGISMUS   STRIDULUS.  79 

character  is  more  prominent,  he  derives  much  satis- 
faction from  the  administration  of  quinine,  as  follows  : 

]pL    Quiniae  sulph.          ...  gr.  i. 

Sig.   Dose,   three  or  four   times   daily,  to   a 
child  of  three  to  five  years. 

If  cachexia  is  more  or  less  marked,  tonics,  iron, 
etc.,  and  plenty  of  fresh  air,  are  required.  As  a  rule, 
under  this  treatment,  and  with  proper  management, 
the  symptoms  disappear  and  convalescence  soon 
follows. 

DR.  A.  L.  LOOMIS  directs  his  attention  primarily 
to  the  removal  of  the  cause  ;  e.  g.,  indigestion,  teeth- 
ing, etc.  If  the  spasm  continues  he  gives  an  emetic, 
or  orders  a  hot  bath,  which  are  often  found  to  act 
beneficially.  In  very  severe  attacks,  however,  when 
relief  does  not  follow,  and  death  seems  impending, 
tracheotomy  is  resorted  to. 

DR.  W.  H.  THOMSON  finds  the  cold  douche  applied 
to  the  nape  of  the  neck,  often  very  serviceable  in  re- 
lieving the  crowing  respiration. 

DR.  A.  A.  SMITH  advises  that  in  most  cases  of 
spasmodic  croup  of  reflex  origin,  the  following  will 
usually  afford  relief : 

^.    Atrophiae  sulph.          .         .         .    gr.  T£¥. 
Aquas          .....          Oss. 

M.    Sig.  A  teaspoonful  every  hour. 

Or,   if  necessary,  the  dose  is  repeated  every  half- 


80  LARYNGISMUS   STRIDULUS. 

hour,  according  to  the  severity  of  the  attack.  Should 
the  child's  face  begin  to  flush  and  show  signs  of  the 
the  physiological  action  of  the  drug,  he  then  reduces 
the  frequency  of  administration.  Attention  is  also 
directed  to  the  stomach,  and  if  it  contains  anything 
which  can  be  causing  the  spasm,  an  emetic  is  given ; 
or  a  cathartic,  if  there  is  reason  to  suspect  intestinal 
disturbance  as  the  cause. 

DR.  FRANCIS  DELAFIELD,  in  treating  those  cases 
which  occur  among  weak  and  poorly  nourished 
children,  and  in  rickety  subjects,  directs  his  measures 
toward  improving  the  general  health  and  nutrition 
of  the  patient  by  means  of  good  food  &i\&  tonics,  such  as 
iron,  quinine,  cod  liver  oil,  etc.,  and  by  sponging  off  the 
child  with  cold  water  each  morning.  Antispasmodics 
are  avoided.  At  the  onset  of  the  attack  he  advises 
that  nothing  special  in  the  way  of  treatment  is  called 
for ;  but  if  the  spasm  continues  and  suffocation  is 
imminent,  tracheotomy  should  be  performed,  al- 
though probably  with  very  little  benefit.  In  sud- 
den emergencies,  however,  he  directs  that  an  ordin- 
ary silver  catheter  be  passed  through  the  opening  of 
the  glottis  into  the  larynx  and  trachea,  thus  estab- 
lishing respiration  ;  and  after  this  is  again  secured, 
the  instrument  may  be  withdrawn  when  the  breath- 
ing will  usually  continue. 

In  other  cases,  where  the  affection  is  purely  mus- 


LARYNGISMUS   STRIDULUS.  8 1 

cular,  DR.  DELAFIELD  administers  an  emetic,  pre- 
ferring the  following : 

9,.     Hydrarg.  sulph.  flav.  .         .         gr.  iii.-v. 
Sig.  Dose,  to  be  repeated  if  necessary. 

Or  he  sometimes  uses  the  wine  of  ipecac  in  doses  of 
3  i.  In  either  case  he  combines  the  use  of  the  hot 
bath  very  effectually  with  the  above.  After  emesis 
has  taken  place,  should  the  child  again  commence  to 
have  difficult  breathing,  the  emetic  is  repeated.  To 
prevent  a  recurrence  of  the  disease,  he  finds  the 
bromides  and  assafcetida  most  efficacious ;  or  some- 
times opium,  chloroform,  or  compound  spirit  of 
ether  have  good  effect. 


HOOPING  COUGH. 


DR.  J.  LEWIS  SMITH  has  treated  several  cases  at 
the  New  York  Foundling  Asylum,  with  very  favor- 
able results,  by  inhalation  of  the  following  mixture : 

1$.     Acid,  carbol 3  ss. 

Potass,  chlorat 3  ii. 

Glycerinae 5  n'- 

Aquae %vi. 

M.    Sig.  Spray. 
6 


82  HOOPING  COUGH. 

This  is  to  be  inhaled  three  times  daily,  and  from  two 
to  five  minutes  each  time.  The  good  effects,  he  ad- 
vises, seem  at  times  to  be  due  principally  to  the  car- 
bolic acid,  although  in  one  or  two  cases,  where  the 
experiment  was  made  of  omitting  the  chlorate  of 
potash  temporarily,  the  patient  apparently  did  better 
without  it. 

DR.  A.  JACOBI  advises  the  importance  of  never 
allowing  the  disease  to  run  on  for  months,  reasoning 
that  it  is  self-limited  and  must  take  a  certain  course-. 
But  every  endeavor  should  be  exerted  to  cure  the 
case  in  five  or  six  weeks,  for  if  permitted  to  continue 
it  may  give  rise  to  secondary  pneumonia.  These 
pneumonias,  occurring  secondary  to  hooping  cough, 
are  most  dangerous  complications,  and  every  means 
should  be  employed  to  prevent  them. 

At  St.  Luke's  Hospital,  DR.  J.  R.  LEAMING  has 
used  cerium  oxalate  in  doses  of  gr.  iii.-v.  with  much 
benefit  in  allaying  the  cough. 

DR.  H.  S.  DESSAU  prescribes  the  following  with 
excellent  effect,  in  the  convulsive  stage : 

IpL    Chloral,  hydrat.  .         .         .         .  3  i« 

Potass,  bromid.  .        .        .        .          3  ii- 
Syrup,  pruni  virg. 
Aquae          .         .         .         .         .       aa  3  i.    . 

M.  Sig.  A  teaspoonful  three  times  daily,  to  a 
child  under  one  year. 


HOOPING  COUGH.  83 

DR.  A.  L.  LOOMIS  directs  that  all  exposure  be 
avoided,  the  child  placed  on  a  simple  nourishing 
diet,  and  the  condition  of  the  alimentary  tract  be 
carefully  attended  to.  In  older  children,  he  advises 
that  they  be  instructed  to  restrain  the  cough  when 
possible.  To  lessen  the  intensity  of  the  paroxysms, 
he  finds  belladonna  very  serviceable  in  some  instan- 
ces ;  in  others,  hydrocyanic  acid  or  cannabis  indica 
affords  most  relief.  He  advises,  however,  that  these 
drugs  should  be  given  in  very  small  doses,  and  their 
effects  carefully  watched.  Topical  applications  and 
counter-irritation  he  believes  to  be  harmful ;  and  he 
has  no  faith  in  the  numerous  specifics  recommended 
for  this  affection.  For  the  complications  occurring 
in  the  course  of  the  disease,  these  are  promptly  met 
in  the  usual  manner,  together  with  supporting 
measures.  In  many  cases  tonics,  iron,  quinine,  and 
cod  liver  oil,  are  found  very  beneficial ;  and  in  all  in- 
stances during  convalescence,  the  administration  of 
these  remedies  is  usually  called  for. 

The  following  mixtures  are  much  used  at  BELLE- 
VUE  HOSPITAL,  in  this  disease : 

Ijfc.  Potass,  bromidi         .         .        .        gr.  xvi. 

Syrup,  ipecac. 

Tinct.  opii  camph.    . 

Syrup,  lactucarii 

Syrup,  tolutan.          .         ..        .       aa  5SS- 


84  EPISTAXIS. 

Aquae  q.  s.  ad  .  §  'lv- 

M.  Sig.  A  teaspoonful. 
Or  this : 
$.  Tinct.  nucis  vom.  .  3ii. 

Vini  ipecac.  ...  3  iiss. 

Syrup,  sarsap.  co. 

Syrup,  senegas       .         .         .  aa  3  iss. 

M.  Dose :  A  teaspoonful. 

At  the  INFANTS'  HOSPITAL  the  following  is  used 
with  very  gratifying  results  : 

IpL  Acid,  nitric,  dil.  .         .        .  3i. 

Syrup,  pruni  virg.         .         .         .          §  ss. 

Aquae  q.  s.  ad  ...          ^  "• 

M.  Dose  :  A  teaspoonful. 


EPISTAXIS. 


DR.  A.  JACOBI  advises  that  in  all  cases  when  the 
bleeding  is  profuse,  it  should  be  stopped  at  once,  if 
possible,  on  account  of  the  drain  on  the  general  sys- 
tem. He  considers  it  a  very  bad  plan  to  wash  out 
the  nares  freely  with  water  and  weak  astringents, 
since  this  interferes  with  coagulation  which  is  essen- 
tial for  the  control  of  the  hemorrhage.  Styptic  cot- 


EPISTAXIS.  85 

ton,  or  the  persulphate  of  iron,  he  finds  very  service- 
able in  these  instances.  Or,  in  some  cases,  when 
necessary  he  uses  Bellocs  canula,  closing  up  the  en- 
tire nasal  tract  to  effectually  stop  the  bleeding.  In 
addition,  he  advises  that  it  is  desirable  to  avoid  all 
tight  pressure  about  the  body,  and  directs  that  the 
child  be  made  to  take  very  deep  inspirations,  filling 
the  chest  to  the  utmost  extent,  so  that  there  maybe 
as  small  an  amount  of  blood  as  possible  for  the  nose. 

DR.  G.  M.  LEFFERTS  uses  the  following  with  very 
good  effect : 

1$.  Acidi  tannic.         .         .         .         .   .      §ss. 

Pulv.  acaciae          .... 

Sacchari  alb.         .         .         .  aa  3  ii. 

M.  Sig.  For  insufflation. 

DR.  W.  H.  DRAPER  finds  that  stuffing  the  nares 
with  lint  dipped  in  ice-water  is  often  successful  in 
arresting  the  hemorrhage.  Or,  in  some  instances, 
plugging  the  nares,  either  anterior  or  posterior,  or 
both,  is  required.  Internally,  in  cases  of  severe 
bleeding,  he  gives  ext.  ergot,  fl.  in  doses  of  m.  xv-  3  ss. 
every  two  hours,  together  with  gallic  acid  gr.  ss—ii. 
in  capsules. 

DR.  ALONZO  CLARK  sometimes  uses  pressure  very 
serviceably  in  checking  the  hemorrhage.  When, 
however,  the  bleeding  is  very  profuse,  causing  con- 
siderable pallor,  etc.,  and  in  obstinate  cases  where 


86  EPISTAXIS. 

this  means  fails  to  relieve,  he  finds  that  a  spray  of 
the  following  solution,  when  thrown  into  the  nostril, 
is  quite  efficacious: 

Ijt.  Liq.  ferri  persulph.         .   •  .          3  i- 

Aquae  3iv-vi. 

M. 


PART  III. 

DISEASES  OF  THE  DIGESTIVE 
ORGANS. 


STOMATITIS. 


In  cases  of  simple  stomatitis,  DR.  J.  LEWIS 
SMITH  considers  the  adoption  of  suitable  hygienic 
measures  of  the  greatest  importance,  and  in  many 
cases  not  any  medicinal  treatment  whatever  is  called 
for.  Locally  he  uses  borax  with  very  good  effect,  as 
follows : 

]jfc.     Sodii  biborat 3i. 

Glycerinae 

Aquae  .        .        .        .  aa§ss. 

M. 

The  ulcerative  form,  he  advises,  requires  the  mosi 
careful  attention  to  cleanliness,  good  surroundings, 
and  plenty  of  fresh  air.  Tonics  are  also  used,  iron 
and  the  vegetable  bitters,  with  also  cod  liver  oil,  when 
indicated.  For  local  treatment,  he  considers  the 


88  STOMATITIS. 

chlorate  of  potassium  as  probably  the  most  efficient 
remedy,  giving  it  thus : 

9-     Potass,  chlorat.  .         .         .      3-ssi. 

Mellis ^ss. 

Aquae  .         .         .       ' .         .       ^  ii- 

M.     Sig.     A  teaspoonful  every  two  hours. 

This,  he  directs,  should  be  taken  in.to  the  mouth 
and  permitted  to  flow  over  the  affected  parts,  to  ob- 
tain its  local  effect. 

In  cases  of  cancrum  oris,  DR.  SMITH  endeavors 
to  build  up  the  constitution  by  good  nutritious  food, 
tonics,  etc.  To  arrest  the  gangrene,  he  has  in  sev- 
eral instances  derived  good  results  from  the  follow- 
ing: 

IjL    Cupri  sulph.         .        .        .         .        3  ii. 
Pulv.  cinchonae     .         .         .  §  ss. 

Aquas ^iv. 

M. 

This  he  applies  twice  daily  over  the  entire  ulcerated 
surface.  If  this  means  fails,  however,  and  the  gangrene 
continues  to  spread,  he  then  uses  strong  muriatic 
acid,  applying  it  carefully  by  means  of  a  camel's-hair 
brush,  touching  only  the  diseased  parts.  This  is  at 
once  followed  by  an  alkaline  wash. 

DR.  J.  H.  RIPLEY,  and  also  DR.  C.  J.  MACGUIRE, 
has  used  bismuth  successfully  in  a  large  number  of 
cases  of  cancrum  oris,  as  well  as  in  ulcerative  stoma- 


STOMATITIS.  89 

titis.  The  following  plan  is  adopted  by  him.  After 
thoroughly  cleansing  -the  mouth  and  the  cavity  in 
the  cheek  with  the  following  disinfectant  lotion : 

Ijfc.   Potass,  permang.            .         .         .          3  i- 
Aquae §  iv. 

M.  Sig.  To  be  applied  once  daily, 
he  then  clips  away  all  the  gangrenous  tissue,  and 
packs  the  ulcerated  surface  with  bismuth  subnitrate, 
repeating  the  process  every  three  hours  ;  at  the  same 
time  washing  out  the  mouth  with  a  solution  of  car- 
bolic acid,  or  the  permanganate  of  potash  solution. 
The  effect  of  this  treatment  is  a  clearing  away  of 
the  slough,  frequently  within  twenty-four  hours,  a 
lessening  of  the  fetor,  and  a  diminution  of  the  gen- 
eral symptoms.  Constitutional  treatment  is  also 
carefully  attended  to.  Syr  up  i  ferri  iodidi,  or  quinine 
and  iron,  and  cod  liver  oil  are  administered  internally, 
together  with  a  generous  and  nourishing  diet.  This 
local  application  of  subnitrate  of  bismuth  is  claimed 
to  be  almost  a  specific  for  this  terrible  malady.  In 
nearly  every  instance  the  treatment  has  invariably 
been  followed  by  good  results  ;  an  immediate  im- 
provement in  the  appearance  of  the  ulcers  takes 
place,  and  eventually  a  complete  cure. 

The  value  of  bismutJi  in  gangrenous  stomatitis,  as 
well  as  in  the  ulcerative  form,  has  also  been  fairly 
tested  at  the  NURSERY  AND  CHILD'S  HOSPITAL. 


90  TONSILLITIS. 

The  parts  are  first  thoroughly  cleansed  with  carbolic 
acid  solution,  cauterized  with  the  solid  stick  of  silver 
nitrate,  and  then  packed  with  bismuth.  Iron,  qui- 
nine, and  li'Jiiskey,  are  also  given  according  to  indica- 
tions. In  one  case,  however,  bismuth  failed,  while 
alum  cured  the  disease.  From  the  results  of  the 
bismuth  treatment  in  this  hospital,  and  from  ex- 
perience, more  confidence  is  expressed  in  the  use  of 
the  solid  nitrate  of  silver,  followed  by  the  applica- 
tion of  alum,  or,  what  is  considered  better,  alum 
combined  with  bismuth,  than  in  the  use  of  bismuth 
subnitrate  alone.  Moreover,  bismuth  is  regarded  as 
being  no  more  of  a  specific  for  ulcerative  stoma- 
titis and  cancrum  oris,  than  is  pilocarpine  for  diph- 
theria. 


TONSILLITIS. 


In  cases  seen  at  the  onset,  DR.  A.  JACOBI  has 
found  usually  prompt  improvement  take  place  under 
the  administration  of  potassium  chlorate  and  the  mn- 
riated  tincture  of  iron.  Should  any  whitish  films 
appear,  after  removing  them  he  often  uses  a  spray  of 
silver  nitrate,  of  the  strength  of  1-500,  with  good 


TONSILLITIS.  91 

effect.  In  regard  to  unilateral  inflammation  of  the 
tonsil  or  pharynx,  he  calls  attention  to  the  rarity  of 
its  occurrence,  and  advises  that  when  present  it 
should  arouse  a  suspicion  as  to  the  existence  of  a 
contagious  disease,  and  especially  diphtheria. 

DR.  J.  R.  LEAMING  finds  that,  if  seen  at  the  com- 
mencement of  the  attack,  the  disease  may  often  be 
aborted.  For  this  purpose  he  gives  the  following 
very  successfully : 

$.  Hydrarg.  chlor.  mit.  .  .  .  gr.  ii. 
Antim.  et  potass,  tart.  .  .  .  gr.  £. 
Sacchar.  ....  gr.  iii. 

M.  Sig.  Dose,  every  three  hours,  to  a  child  of 
eight  to  ten  years. 

This  he  places  dry  upon  the  back  of  the  tongue, 
and  repeats  the  dose,  as  above,  until  free  catharsis  is 
produced.  Or,  when  the  inflammation  is  too  far  ad- 
vanced to  be  aborted,  he  also  uses  this  prescription 
with  marked  benefit  in  hastening  the  suppurative 
stage. 

DR.  FRANCIS  DELAFIELD  first  administers  a  purge 
of  calomel,  after  which  he  endeavors  to  abort  the  dis- 
ease, if  possible,  by  means  of  cold  both  within  and 
without,  together  with  the  internal  use  of  aconite. 
When  the  inflammation  has  gone  on  to  suppuration, 
he  then  discontinues  the  aconite  and  resorts  to  warm 
applications,  steam  inhalations,  etc.  If  there  is  much 


92  TONSILLITIS. 

pain  present,  opium  in  some  form  is  given  to  relieve 
it.  When  accumulations  of  mucus  take  place  in 
the  mouth,  he  finds  a  mild  solution  of  alum  or  borax 
very  effective  in  removing  them,  used  either  as  a 
wash  or  gargle.  In  regard  to  surgical  interference, 
he  advises  that  if  the  swelling  of  the  tonsils  is  not 
very  great,  and  the  discomfort  of  the  patient  not 
beyond  endurance,  the  knife  should  not  be  resorted 
to.  In  any  case,  however,  no  attempt  should  be 
made  to  open  the  abscess  before  the  fifth  or  sixth 
day;  not  until  it  has  pointed,  or  until  the  yellow  pus 
can  be  seen  through  the  mucous  membrane.  As  a 
rule,  too  early  cutting,  he  finds,  does  harm,  and 
while  the  sufferings  of  the  patient  must  be  the  guide 
to  this  procedure,  yet  he  considers  it  much  better  to 
let  the  tonsil  break  of  itself,  if  possible.  Where  the 
uvula  is  involved,  causing  much  distress,  he  obtains 
considerable  relief  from  touching  it  with  the  scarifi- 
cator ;  or,  if  necessary,  passing  a  bistoury  into  it, 
cutting  from  above  downward.  The  following  is 
very  extensively  employed  at  BELLEVUE  HOS- 
PITAL : 

9.    Sodii  biboratis     .         .         .         .         3  "• 

Fermenti 

Mellis aa  3  ss. 

Aquae  q.  s.  ad  .         .  §  viii, 

M.    Sig.  Gargle. 


TONSILLITIS.  93 

DR.  F.  H.  BOSWORTH  believes  that  he  has,  in 
many  cases  of  commencing  tonsillitis,  aborted  the 
disease  before  the  suppurative  period  has  been 
reached.  To  accomplish  this,  he  gives  quinice  sulph. 
gr.  x.  followed  by : 

Ijfc.    Tinct.  aconit.  rad.        .         .  gtt.  v— x. 

Aquae  .         ...         .         .         q.  s. 

M.    Sig.  Dose. 

This  is  repeated  until  dryness  of  the  throat,  nausea, 
and  ringing  in  the  ears,  show  their  constitutional 
effects. 

DR.  W.  H.  DRAPER  is  sometimes  able  to  abort 
the  inflammation  by  the  use  of  small  blisters  and 
poultices.  Sinac,  which  has  been  said  to  be  a  cure, 
will,  in  his  experience,  fail  more  often  than  it  will 
succeed.  Astringent  washes  and  gargles  are  also 
used  by  him,  at  times,  together  with  the  internal 
administration  of  aconite  arid  belladonna  to  control 
the  circulation  in  this  region.  The  following  car- 
bolic throat  spray,  used  at  NEW  YORK  HOSPITAL, 
is  a  most  excellent  and  valuable  combination : 

]^,.    Sodii  bicarb.       .... 

Sodii  biborat aa3i. 

Acidi  carbol gr.  xl. 

Glycerinae           ....          3  vii. 
Aquae §viii. 

M. 


94  TONSILLITIS. 

DR.  F.  A.  BURRALL  finds  that  gargles  are  of 
marked  service  as  a  temporary  substitute  for  poulti- 
ces, a  warm  gargle  frequently  repeated  affording 
much  relief  and  aiding  suppuration.  He  also  ad- 
vises that  constitutional  treatment  should  not  be 
neglected ;  a  mercurial  purge  at  the  beginning  is 
considered  of  great  value.  When  the  case  is  seen  at 
the  onset,  he  prescribes  the  following  with  very 
satisfactory  result,  and  advises  that  if  used  at  the 
first  intimation  of  the  attack,  its  beneficial  effects  are 
often  remarkable : 

IJ.    Acid,  carbol'.  gfc  xx. 

Glycerinae        ....  ^ 1- 

Sodii  chloridi  ...  3  i- 

Aquae  ferv.       .         .         .         .  Oss. 

M.    Sig.  Gargle,  to  be  used  every  half-hour. 

DR.  G.  M.  LEFFERTS  directs  attention  to  the  fact 
that  when  once  a  patient  has  suffered  from  this  dis- 
ease, a  second  attack  is  more  liable  to  occur.  In 
order  to  prevent  this  recurrence,  if  there  is  chronic 
inflammation  he  advises  that  the  tonsil  be  excised ; 
or  if  it  is  too  small  for  this  operation  to  be  per- 
formed at  any  other  time  except  when  it  is  acutely 
inflamed,  it  should  be  done  then.  By  this  means  he 
believes  that  the  chances  of  recurrence  are  almost 
avoided,  although  even  this,  he  finds,  will  not  always 
prevent  a  return  of  the  inflammation.  For  the 


TONSILLITIS.  95 

affection  itself,  when  the  development  of  suppura- 
tion is  once  assured,  he  treats  it  as  an  abscess  else- 
where. He  is  doubtful  as  to  the  possibility  of  abort- 
ing it.  Silver  nitrate,  when  applied  for  this  purpose, 
he  finds,  only  produces  separation  of  the  slough,  and 
causes  pain  and  annoyance  to  the  patient.  Constant 
application  of  heat  and  moisture,  internally  and  ex- 
ternally, he  considers  the  best  remedial  means.  As 
to  medicated  sprays,  although  possibly  of  some 
benefit,  yet  he  thinks  it  questionable  whether  it  is 
not  merely  the  warm  vapor  that  produces  the  result. 
He  believes  there  is  no  better  treatment  than  by  the 
hourly  inhalation  of  steam,  as  hot  as  can  be  borne, 
combined  with  the  following  gargle  : 

~fy.    Zinci  chloridi         .         .         .       gr.  ii-iii. 
Aquae %  i. 

M. 

Regarding  gargles,  however,  he  advises  that  they 
are  not  always  of  service,  and  sometimes  do  positive 
harm.  Using  them  three  or  four  times  daily  is  con- 
sidered insufficient.  He  directs  the  patient  to  use 
only  a  tablespoonful  at  a  time,  but  to  repeat  it  at 
least  a  dozen  times  a  day.  The  partial  act  of  swal- 
lowing he  finds  an  excellent  manner  of  doing  this  ; 
or  by  throwing  the  head  backward  and  simply  letting 
the  fluid  flow  back  by  force  of  gravity,  is  just  as 
efficacious  and  more  easily  accomplished.  He  also 


96  TONSILLITIS. 

objects  to  the  application  of  leeches  and  counter-irri- 
tants, as  these  measures  only  serve  to  exhaust  the 
patient's  strength.  In  his  experience,  also,  as  little 
medicine  as  possible  should  be  given,  and  if  an 
emetic  is  tried,  a  non-depressant  one  should  be  used. 
Cathartics  are  also  employed  to  relieve  congestion  of 
the  alimentary  tract.  Regarding  scarification,  he 
believes  there  can  be  no  doubt  as  to  its  propriety, 
since  it  causes  little  or  no  pain,  affords  relief  at 
once,  and  may  open  into  an  abscess  or  make  its  sub- 
sequent spontaneous  opening  more  easy  by  leaving 
a  path  for  it.  When  the  existence  of  pus  is  made 
out,  he  opens  it  at  once.  The  following  is  also 
much  used  by  him  : 

R.    Potass,  chlorat.        ...         3  Ss-ii. 

Glycerinae 3  ii. 

Aquae § x- 

M.    Sig.  Gargle. 

In  cases  of  chronic  enlargement  of  the  tonsils,  DR. 
LEFFERTS  thinks  that  too  little  regard  is  paid  to 
active  treatment,  and  directs  attention  to  the  unwil- 
lingness of  parents  to  use  remedies,  as  they  believe 
that  the  children  will  outgrow  it.  He  finds  that 
where  the  case  is  comparatively  recent,  the  tumor  is 
soft  and  constitutional  treatment  will  often  result  in 
its  absorption.  Local  measures  are  also  tried  at 
times,  such  as  application  of  silver  nitrate,  massage 


TONSILLITIS.  97 

of  the  tonsil,  etc.  But  when  the  enlargement  is  of 
long  standing  and  the  tonsils  have  become  indurated, 
a  train  of  more  serious  results  may  follow.  In  such 
cases,  therefore,  he  resorts  to  excision,  believing  that 
the  results  of  other  methods,  iodine,  caustics,  etc., 
are  unsatisfactory.  He  advises,  however,  that  it  is 
not  necessary  to  remove  the  whole  gland,  only  the 
part  in  front  of  the  anterior  palatine  fold ;  but  the 
subsequent  cicatrization  must  not  be  counted  upon 
too  much. 

DR.  BEVERLY  ROBINSON  also  advises  excision  of 
the  tonsils,  where  there  is  a  condition  of  chronic 
hypertrophy  and  enlargement.  If,  however,  this 
cannot  be  done,  he  sometimes  uses  silver  nitrate  with 
good  effect. 

DR.  FRANK  H.  HAMILTON  regards  an  hypertro- 
phied  condition  of  the  tonsils  as  one  form  of  mani- 
festation of  the  strumous  diathesis.  He  finds,  more- 
over, that  these  enlargements  have  usually  their  own 
definite  period  of  growth  and  decline.  They  com- 
mence generally,  according  to  his  observations,  about 
the  second  or  third  year  of  life,  and  usually  reach 
their  highest  development  about  the  tenth  or  twelfth 
year ;  after  which  they  gradually  diminish  in  size, 
and  are  rarely  sufficiently  large  after  about  the 
twentieth  year,  to  cause  any  inconvenience.  There- 
fore he  does  not  consider  that  the  mere  fact  that  the 
7 


98  PHARYNGITIS. 

tonsils  are  enlarged,  justifies  excision,  and  this  he  is 
in  the  constant  habit  of  saying  to  parents  who  bring 
their  children  to  him.  In  any  case,  however,  he 
would  not  operate  when  the  tonsils  were  in  the 
slightest  degree  inflamed,  unless  the  danger  of  suffo- 
cation was  imminent,  from  fear  of  setting  up  acute 
inflammation  or  causing  copious  and  frequently 
recurring  hemorrhage,  either  of  which  might  prove 
fatal.  He  also  considers  the  existence  of  a  decided 
hemorrhagic  diathesis  a  strong  contraindication  to 
operation.  DR.  HAMILTON  prefers  to  use  his  own 
modification  of  Owen's  instrument,  after  which  the 
bleeding  is,  as  a  rule,  very  trifling,  and  usually  ceases 
in  a  few  moments  of  itself,  or  by  washing  the  throat 
with  cold  water. 


PHARYNGITIS. 


Where  chronic  pharyngitis,  which,  as  a  rule,  is 
more  common  in  children  than  the  acute  form,  is 
associated  with  naso-pharyngeal  catarrh,  as  is  usually 
the  case,  DR.  A.  JACOBI  -insists  upon  absolute  clean- 
liness and  washing  out  the  nares  regularly,  several 
times  daily,  with  a  tepid  solution,  using : 


PHARYNGITIS.  99 

$.    Sodii  chloridi        .         .        .         .         3i« 
Aquae Oi. 

M.    Sig.  This  amount  once  or  twice  daily. 

This,  he  directs,  must  be  snuffed  up  the  nose  until 
it  can  be  spit  out  through  the  mouth.  The  plan  is 
usually  very  successful,  and  he  considers  it  preferable 
to  the  nasal  douche,  which  sometimes  causes  bad 
results  and  is  objectionable.  In  addition  to  this,  a 
kettle  of  boiling  water  is  kept  constantly  in  the  room, 
where  the  child  can  breathe  it  continually.  Where 
a  medicated  application  is  desired,  he  employs  the 
nitrate  of  silver  in  mild  solution  of  gr.  %-\\. —  5  *•> 
according  to  the  severity  of  the  case.  The  stick  or 
concentrated  solution,  however,  he  considers  exceed- 
ingly dangerous.,  often  setting  up  an  incurable  con- 
dition. As  a  rule,  he  uses : 

$.    Argenti  nitrat.  gr.  ss-i. 

Aquae          .         .        .        ...  §i. 

M. 

This  he  injects  twice  a  week,  seeing  that  it  enters 
the  pharynx  properly ;  while,  during  the  intervals, 
the  child  is  instructed  to  attend  carefully  to  the  salt 
and  water  washing. 

DR.  JACOBI  also  calls  attention  to  an  elongated 
condition  of  the  uvula,  which,  when  the  child  lies 
down,  falls  backward  and  touching  the  posterior 
wall  of  the  pharynx  causes  a  sudden  tickling,  thus 


IOO  PHARYNGITIS. 

keeping  up  a  continual  cough.  This  chronic  state 
of  things  in  the  pharynx,  he  advises,  if  allowed  to  go 
on,  results  in  dangerous  consequences.  The  cough 
itself  is  a  source  of  constant  irritation,  and  eventu- 
ally sets  up  a  catarrh  in  the  trachea  and  bronchi. 
His  treatment  is  to  remove  such  an  elongated  uvula 
as  soon  as  possible.  If  there  is  a  choice,  however, 
he  directs  that  it  should  not  be  done  when  diph- 
theria is  prevailing. 

DR.  A.  H.  SMITH  uses  silver  nitrate  very  effectu- 
ally, in  certain  cases,  where  there  is  a  condition  of 
naso-pharyngeal  catarrh  with  muco-purulent  dis- 
charge. As  a  preparatory  measure,  however,  he  first 
cleanses  the  parts  thoroughly  with  a'  solution  of  so- 
dium nitrate;  after  which  he  employs  the  following, 

^ 

blown  by  means  of  the  insufflator  into  the  anterior 
and  posterior  nares: 

1$.    Argenti  nitrat.  gr.  v. 

Potass,  sulphat.    ....      3  iss. 
Bismuth,  subnit.  ad.          .         .  §  i. 

M.    Ft.  pulv. 

Sig.  To  be  used  daily,  or  every  other  day. 

DR.  F.  H.  BOSWORTH  cautions  against  permitting 
children  to  habitually  breathe  through  the  mouth, 
especially  during  sleep.  This  he  believes  to  be  a 
most  prolific  source  of  throat  catarrh  and  bronchial 
disorders.  In  using  inhalations,  when  the  latter  are 


PHARYNGITIS.  IOI 

attended  with  much  pain  or  irritation,  he  combines 
the  following  with  evident  satisfaction. 

$.     Ext.  hyoscyami  gr.  v. 

Aquae     .         .         .         .         .         .        §  i. 

M. 

DR.  A.  A.  SMITH  prescribes  the  following  with 
marked  effect,  in  those  cases  of  pharyngitis  occurring 
in  older  children,  and  associated  with  dyspepsia: 

$.    Ammon.  chlorid.  .         .         .         3  i- 

Tinct.  cubeb.  .         .         .  §  ss. 

Tinct.  gent,  co §  ss. 

Glycerins:;  ad    .         .         .         .  §  iv. 

M.  Sig.  A  teaspoonful  in  water,  every  two  or 
three  hours. 

As  a  rule,  DR.  FRANCIS  DELAFIELD  considers  it 
best  to  begin  with  a  purge,  especially  in  pretty 
severe  acute  cases.  For  this  purpose  calomel  is  pre- 
ferred by  him,  combined  with  a  moderate  amount  of 
opium  to  relieve  and  quiet  the  patient.  Following 
this,  he  administers : 

];&.    Tinct.  aconit.  rad.          .        .        gtt.  i-ii. 
Liq.  ammon.  acetat.    ...       3  i-ii. 

M.  Sig.  Dose,  every  one  or  two  hours,  accord- 
ing to  age. 

The  local  measures  adopted  by  him  consist,  at  the 
commencement,  in  the  application  of  ice  to  the  throat, 
or  the  use  of  vapor  or  spray  by  the  atomizer.  The 


102  VOMITING — DYSPEPSIA. 

simple  vapor  of  steam  is  used,  or  this  is  sometimes 
modified  by  the  addition  of  vinegar  to  the  water, 
tincture  of  cubebs,  or  other  remedies.  Hot  compresses 
are  also  applied  externally.  After  two  or  three  days 
he  resorts  to  astringents,  in  the  form  of  gargles  and 
sprays  of  alum  or  borax  ;  or  zinc  sulphate,  tannic  acid, 
and  potassium  chlorate  are  also  used  at  times,  either 
of  which,  he  finds,  act  very  well  in  the  later  stages. 

DR.  G.  M.  LEFFERTS  considers  the  following  very 
efficient  when  a  sedative  gargle  is  desired : 

IjL    Potass,  bromidi  ...          3  iss. 

Glycerinae 3  ii- 

Aquae §x. 

M. 

When  an   astringent  is  called  for,  he  finds  the  fol- 
lowing very  serviceable  : 

ty.    Aluminis 3i- 

Acid,  tannic 3  i- 

Aquae §  x. 

M.   Sig.      Gargle. 


VOMITING— DYSPEPSIA 


DR.  J.  LEWIS  SMITH  uses  the  following  with 
marked  benefit,  in  relieving  the  nausea  accompany- 
ing intestinal  trouble  in  infants : 


VOMITING— DYSPEPSIA.  103 

Ijfc.    Acid,  carhol.     ....        gtt.ii.  • 
Aquae  calcis  .         .         .         .       §  ii. 

M.    Sig.     A  teaspoonful. 

This  he  directs  to  be  taken  in  a  teaspoonful  of 
milk,  using  breast  milk  if  the  baby  nurses,  and  re- 
peated according  to  the  nausea. 

At  the  INFANTS'  HOSPITAL  the  following  is  very 
extensively  used : 

P.    Bismuthi  subcarb. 

Pepsini aa  gr.ii. 

M.     Sig.     Dose. 

DR.  A.  H.  SMITH  (also  DR.  G.  B.  FOWLER)  has 
found  beef  peptone  of  excellent  service  in  these  cases. 
Where  the  infant  refuses  to  nurse,  followed  by  per- 
sistent vomiting,  with  probably  diarrhoea,  he  gives 
gtt.  x.  of  beef  peptone,  properly  diluted,  every  two 
hours ;  at  the  same  time  stopping  all  other  food  and 
medication.  This  amount  is,  as  a  rule,  gradually  in- 
creased during  the  week.  Its  administration  is  al- 
most invariably  followed  by  improvement  within  a 
day  or  two  ;  the  vomiting  and  diarrhoea  speedily  and 
entirely  cease,  and  the  child  soon  regains  its  lost 
health  and  strength.  Also  in  cases  of  dyspepsia  of 
long  standing,  where  the  slightest  indiscretion  in  re- 
gard to  food  is  followed  by  a  period  of  great  suffer- 
ing, and  the  usual  remedies  fail  to  give  relief,  beef 
peptone,  in  small  doses  at  first  and  then  gradually 


104  VOMITING— DYSPEPSIA. 

increased  to  teaspoonf  ul  doses  every  three  hours,  af- 
fords more  benefit  and  cuts  short  the  attack  quicker 
than  anything  else.  In  fact,  it  is  found  to  be  uni- 
formly successful  in  all  these  cases  in  improving  nu- 
trition, and  in  being  assimilable  when  all  other  foods 
are  rejected.  It  may  usually  be  given  in  water  and 
sweetened  to  the  taste ;  but  should  the  peptone  be 
objected  to  on  account  of  the  pronounced  flavor  of 
meat,  he  often  adds  it  to  a  simple  broth  with  advan- 
tage, when  it  is  generally  taken  veiy  readily. 

In  those  instances,  so  frequently  met  with,  where 
the  child  is  nursing,  and  vomits  or  regurgitates  its 
food,  DR.  A.  A.  SMITH  finds  the  following,  in  his  ex- 
perience, of  excellent  service  in  relieving  this  condi- 
tion : 

$.    Hydrarg.  chlor.  mit.      .         .         .       gr.i. 
Aquae Oi. 

M.  Sig.  A  teaspoonful  every  ten  or  fifteen  min- 
utes. 

In  preparing  this,  he  advises  that  in  order  to  dis- 
solve it  the  calomel  should  first  be  added  to  aquae 
calcis  §  i,  and  then  to  a  pint  of  pure  water.  Or,  when 
the  vomiting  is  accompanied  with  mucous  discharge, 
he  gives  the  following  with  good  effect : 

$.     Hydrarg.  chlor.  corros.       .         .         gr.ss. 
Aquae Oi. 

M.     Sig.     A  teaspoonful  every  fifteen  minutes. 


VOMITING— DYSPEPSIA.  10$ 

In  those  cases  of  vomiting  due  to  indigestion,  com- 
monly found  in  young  children,  he  gives : 

Ijjfc.    Vini  ipecac.        ....         gtt.i. 
Aquae q.  s. 

M.     Sig.     Dose,  every  ten  or  fifteen  minutes. 

This  he  finds  of  the  greatest  benefit,  and  advises 
that  it  will  often  arrest  the  most  obstinate  vomiting, 
as  well  as  any  diarrhoea  that  may  be  present ;  and, 
moreover,  when  administered  in  this  manner,  the 
drug  is  not  in  the  least  nauseous  and  is  easily  taken. 

In  other  instances,  associated  with  a  simple  non- 
inflammatory diarrhoea,  DR.  SMITH  prescribes 
hydrarg.  cum  cretce,  gr.  &\  every  fifteen  or  twenty 
minutes.  This  he  recommends  with  much  satisfaction 
in  relieving  this  often  exceedingly  troublesome 
condition. 

Many  cases  of  nausea  and  vomiting  in  children  are 
also  promptly  and  thoroughly  relieved  by  the  use  of 
hot  water.  This  is  found  to  be  especially  useful  in 
cases  where  these  symptoms  are  purely  reflex,  and  in 
the  colic  of  newly  born  infants. 

DR.  W.  A.  HAMMOND  uses  the  following  very  suc- 
cessfully, in  the  dyspepsia  occurring  in  older  chil- 
dren and  dependent  upon  nervous  causes : 

Ijfc.    Sodii  bromid ^  i. 

Pepsin,  citrat 

Pulv.  carbon aa  3  iii. 


I06  GASTRITIS. 

Aquae §  iv. 

M.  Sig.  A  teaspoonful  or  less,  according  to  age, 
three  times  daily. 

DR.  F.  DELAFIELD  prescribes  the  following,  which 
is  a  favorite  with  him,  in  cases  of  dyspepsia  in  older 
children : 

Ijjfc.    Pepsini  gr.  iii-v. 

Pulv.  cubeb.  .         .         .         gr.  v-x. 

Bismuthi  subnit.  gr.  v-x. 

M.     Sig.     Dose. 


GASTRITIS. 


In  the  acute  catarrhal  gastritis  of  infants,  in  mod- 
erately severe  attacks,  DR.  F.  DELAFIELD  frequently 
finds  that  simply  diminishing  the  food,  and  doing 
little  or  nothing  else  for  twenty-four  hours,  will  be 
all  that  is  required.  In  severe  cases,  where  there  is 
high  fever,  he  often  employs  sweating  very  service- 
ably  ;  placing  the  child  in  the  hot  bath  for  a  few  min- 
utes and  then  wrapping  in  a  hot  blanket.  Small 
pieces  of  cracked  ice  may  also  be  given  at  intervals. 
In  many  instances,  however,  he  finds  that  the  fever 
is  of  short  duration,  and  calls  for  no  treatment  what- 
ever. To  control  the  persistent  vomiting,  if  the  in- 
fant is  brought  up  on  the  bottle,  he  gives  sodii  bi- 


GASTRITIS.  ID/ 

carbonas  with  milk ;  or  if  the  child  is  nursing,  he  ad- 
ministers milk  with  the  bicarbonate  of  sodium  in  ad- 
dition to  its  ordinary  food ;  in  either  case  giving 
sodii  bicarb,  gr.  iii-iv.  in  §  ss.  of  cream  and  milk,  or 
at  times  using  sugared  water.  In  other  cases  he  em- 
ploys the  following  method  of  administration  very 
effectually : 

$.    Sodii  bicarb.         .         .         .        .         3  i- 
Cremor.  lactis       .... 
Aquae aa  §  iv. 

M.  Sig.  A  teaspoonful,  to  be  taken  every  hour 
whether  retained  or  not. 

Sometimes,  however,  he  obtains  excellent  results 
from  calomel,  in  small  doses  of  gr.  -fa-ss. 

In  children  over  three  years  of  age  he  substitutes 
milk  for  the  water  in  the  mixture,  and  gives  double 
the  dose,  feeding  the  child  on  this  alone  while  the 
attack  is  going  on.  Or,  often  he  finds  that  brandy 
in  small  doses  is  very  -serviceable.  To  relieve  the 
pain,  which  is  usually  prominent  in  these  older  chil- 
dren, he  applies  anodyne  poultices,  or  sometimes  tur- 
pentine stupes,  with  good  effect,  and,  as  a  rule,  admin- 
isters small  doses  of  Dover's  powder,  just  sufficient 
to  diminish  the  pain.  Where  morphia  is  used  for 
this  purpose,  he  advises  that  it  should  be  given  by 
the  stomach,  usually  beginning  with  m.  ii. 


108  ENTERALGIA — ENTERITIS. 


ENTERALGIA  (COLIC)— ENTERITIS. 


DR.  J.  W.  McLANE  prescribes  the  following  with 
very  gratifying  effect  in  the  colic  of  babies : 
Ijfc.    Chloral,  hydrat. 

Sodii  bicarb 

Potass,  bromid.         .         .     aa  gr.  vi-viii. 
Aquae  rosae       ....  %i. 

M.  Sig.  A  teaspoonful,  repeated  every  half-hour 
as  required. 

In  many  cases,  however,  he  prefers  to  use  mint 
water — not  peppermint,  but  green  mint — in  the  above 
formula,  instead  of  aqua  rosae. 

DR.  F.  A.  BURRALL  recommends  the  following  as 
an  excellent  carminative  for  infants  : 

]pL    Tinct.  valerian,  ammon.      .         .          3ii- 
Lactopeptin.  gr.  xxxii. 

Sodii  bicarb.        ...  gr.  xii. 

Glycerinae  .         .         .        .          3  ii- 

Aquae 3  vi. 

Aquae  aurant.  flor.       .         .         .  §  i. 

M.  Sig.  M.  xx-lx.  in  3  i-ii.  of  warm  water  as 
needed. 

This  he  has  found  to  be  an  exceedingly  valuable 
combination,  where  it  is  desirable  to  avoid  an  opiate. 


ENTERALGIA — ENTERITIS.  IOQ 

As  a  rule,  in  cases  of  spasmodic  colic,  DR.  AUSTIN 
FLINT  pays  little  or  no  attention  to  the  cause  of  the 
attack  or  to  the  presence  of  constipation  ;  but  directs 
his  treatment  to  the  relief  of  the  spasm,  especially  by 
the  use  of  opiates,  believing  that  so  long  as  the  spasm 
exists  cathartics  are  of  little  or  no  avail. 

DR.  A.  A.  SMITH  considers  the  following  very 
efficacious  in  relieving  an  attack  of  colic  depend- 
ing on  flatulence : 

]pfc.    Spts.    chloroformi      .        .         .         5SS- 
Tinct.  cardam.  co.  .         .  §  ii. 

M.  Sig.  M.  xv-xxx.  in  a  tablespoonful  of  water, 
every  half-hour  until  relieved. 

DR.  F.  H.  HAMILTON  finds  that  opium  does  not 
always  cure  an  attack  of  colic.  His  later  experience 
has  been  that  this  affection  is  most  quickly  and  most 
permanently  relieved  by  a  full  dose  of  some  aromatic 
and  stimulating  cathartic,  such  as  tincture  of  rhubarb 
with  ginger.  In  certain  cases,  however,  he  finds  that 
only  a  full  dose  of  some  active  sedative  will  succeed. 
But  he  places  greatest  reliance  on  the  mechanical  ef- 
fects of  posture  (regarding  displacement  or  doubling  of 
the  gut  as  the  cause,  at  least  in  the  majority  of  cases, 
rather  than  spasm  or  fecal  obstruction),  not,  how- 
ever, as  a  positive  cure  for  all  cases,  nor  as  a  substi- 
tute for  any  other  suitable  mode  of  treatment ;  but 
particularly  as  a  supplement  to  other  means,  and 


I  IO  ENTERALGIA — ENTERITIS. 

which  may  sometimes  prove  effectual,  or  at  least 
useful.  In  older  children,  he  directs  that  the  patient 
be  made  to  assume  a  position  elevating  the  hips  with 
pillows,  or  over  the  end  of  a  sofa.  Occurring  in  in- 
fants, he  advises  that  a  similar  position  be  secured, 
or  that  the  child  be  raised  by  the  feet  as  if  in  the  act 
of  applying  a  diaper;  thus  elevating  the  lower  part 
of  the  body  so  as  to  cause  the  heavy  organs,  such  as 
the  liver  and  spleen,  to  fall  toward  the  head,  dragging 
the  intestinal  viscera  with  them.  By  this  means,  DR. 
HAMILTON  often  finds  that  there  is  an  almost  imme- 
diate discharge  of  gas  from  the  rectum,  and,  in  in- 
fants, often  a  free  fecal  evacuation,  with  the  effect  of 
prompt  and  complete  relief  of  the  colic. 

At  the  INFANTS'  HOSPITAL  the  following  is  con- 
stantly employed: 

]pfc.     Infusi  anisi  (5  ii-Oi.) 

Genevae.  .         .         .         .          aa§i. 

M.    Dose  :  Half  a  teaspoonful. 

At  the  NEW  YORK  HOSPITAL  the  following  com- 
bination is  considered  to  be  highly  valuable  as  a 
carminative : 

IjL    Tinct.  opii    ....        gtt.  xx. 
Ol.  anisi        .... 
Ol.  caryophyl. 

Ol.  gaulth aagtt.ii. 

Tinct.  asafcetid.    ...  3  i. 


ENTERALGIA — ENTERITIS.  1 1 1 

Magnes.  carbon.  .         .         .  .       3i- 

Aquae  menth.  pip.         .  .     §  iii. 

M. 

In  cases  of  nursing  infants,  where  after  taking 
milk  there  follows  a  colicky  condition,  with  griping 
pains,  etc.,  the  following  mixture  is  found  by  many 
to  afford  speedy  relief  to  these  often  frequent  and 
exceedingly  annoying  attacks : 

$.    Potass,  carbon.  .         .         .         gr.ii. 

Ol.  cajuput m.i. 

Aq.  anethi         .         .         .         .          3ii. 

M.    Sig.  Dose,  three  or  four  times  daily. 

In  pure  enteritis,  DR.  F.  DELAFIELD  advises  the 
importance  of  an  early  diagnosis,  since  the  treatment 
varies  greatly  from  that  of  peritonitis,  with  which  it 
is  sometimes  apt  to  be  confounded.  He  first  admin- 
isters a  purge,  usually  preferring  a  full  dose  of  castor 
oil ;  or  calomel,  gr.ii-vi.  in  three  divided  doses  one 
hour  apart,  adding  also  a  little  Dover's  powder  to  the 
calomel.  After  this,  and  during,  the  first  day  or  two 
of  the  disease,  he  finds  the  use  of  opium  to  relieve 
the  pain,  very  advantageous,  but  directs  that  this 
must  not  be  continued  after  the  fever  has  much  di- 
minished, even  though  the  pain  persists,  as  opium 
then  is  apt  to  make  matters  worse.  During  this 
early  period  he  advises  that  the  diet  be  regulated  as 
near  to  nothing  as  possible,  usually  consisting  of 


112  DIARRHCEA. 

milk,  until  the  fever  has  subsided.  After  the  first 
twenty-four  or  thirty-six  hours,  he  places  the  patient 
on  small  and  gradually  increasing  doses  of  ipecac  ;  at 
this  stage  of  the  disease,  also,  he  orders  a  diet  of  beef- 
tea  for  a  few  days,  followed  after  a  while  by  the  more 
ordinary  articles  of  food,  avoiding  starches  and  milk. 


DIARRHCEA. 


In  infantile  diarrhoea  due  to  indigestion  and  at- 
tended by  acidity,  DR.  J.  LEWIS  SMITH  finds  the 
following  very  effective : 

IJ.    Pulv.  ipecac gr.  ss. 

Pulv.  rhei  gr.  ii. 

Sodii  bicarb.      .         .         .  gr.  xii. 

M.    Div.  in  chart.  No.  xii. 

Sig.  One  powder  every  four  to  six  hours,  to  an 
infant  one  year  old. 

In  a  large  majority  of  cases,  however,  he  employs 
the  following  combination.  If  it  fails  to  relieve,  and 
the  regimen  has  been  carefully  attended  to,  he  con- 
cludes that  in  all  probability  there  is  inflammation  of 
the  intestinal  mucous  membrane. 

Ijfc.    Tinct.opii  deodor.         .         .         gtt.  xvi. 
Bismuthi  subnit.  .         .         .  3  ii- 


DIARRHCEA.  113 

Syrupi  simp.         .         .        .  §  ss. 

Mist,  cretae          .        .         .        .5  '1SS> 
M.    Sig.  A  teaspoonful  every  three  or  four  hours, 
to  an  infant  of  one  year. 

For  the  simple  diarrhoea  occurring  in  older  children 
he  generally  gives : 

Ijfc.    Bismuthi  subnit.  gr.  xxx. 

Cretae  praecipit.  gr.  xxx. 

Pulv.  opii     ....  gr.  i. 

M.    Div.  in  pulv.  No.  x. 

Sig.  One  powder  every  three  or  four  hours,  as 
required. 

In  giving  bismuth  to  children,  DR.  E.  G.  JANEWAY 
calls  attention  to  the  mode  of  administration.  He 
finds  that  it  is  very  common  for  the  physician  to 
direct  that  it  be  taken  in  water  or  milk,  and  it  is 
noticed  by  the  mother  or  nurse  that  the  drug  sticks 
to  the  bottom  of  the  spoon,  and  makes  the  child  gag 
in  swallowing  it.  Therefore,  in  young  children,  he 
advises  that  it  is  not  best  to  give  bismuth  in  large 
doses,  and  to  administer  it  with  something  which  will 
hold  the  powder  in  suspension ;  some  mucilaginous 
material.  He  also  directs  that  the  mother  be  in- 
structed as  to  the  effect  of  the  drug  on  the  color  of 
the  passages,  and  to  the  disagreeable  odor  which  is 
sometimes  present  from  the  fermentation  of  the 


1 14  DIARRHCEA. 

mucus  ;  thus  avoiding  unnecessary  and  often  serious 
alarm. 

DR.  A.  A.  SMITH  recommends  the  following  as 
very  serviceable  in  cases  of  diarrhoea  dependent  upon 
intestinal  irritation  : 

IJ.    Ol.  ricini         ....          gtt.  v. 
Sacchar.  ....  q.  s. 

M.    Sig.  Dose,  to  be  given  every  two  hours. 

He  also  uses  the  ivine  of  ipecac,  in  doses  of  gtt.  i. 
every  ten  or  fifteen  minutes,  with  excellent  effect  in 
arresting  diarrhoea  due  to  indigestion ;  this  he  finds 
particularly  useful  where  there  is  also  vomiting 
present,  and  advises  that  when  given  in  this  manner, 
the  drug  is  easily  taken  and  has  not  the  slightest 
nauseating  effect.  Hydrarg.  cum  cretce,  gr.  <fa  every 
fifteen  minutes,  is  also  recommended  by  him  in  cases 
of  simple  diarrhoea  associated  with  vomiting.  In 
older  children,  where  an  anodyne  and  stimulant  is 
indicated,  he  prescribes  the  following  with  much 
satisfaction : 

5&.    Spts.  ammon.  aromat.     . 

Spts.  chloroformi    .... 
Tinct.  camphorae     .... 
Tinct.  opii  deodor  .         .         .         .  aa3ii 
Tinct.  capsici          .         .         .  3  i- 

M.    Sig.  M.  x-xx.  in  a  wineglass  of  water. 

In   diarrhoea   due   to    food,  whether  acting  as  a 


DIARRHCEA.  115 

purge  or  as  an  irritant,  DR.  F.  DELAFIELD  usually 
controls  it  by  the  use  of  castor  oil,  or  sometimes  rhu- 
barb. Where,  however,  the  irritation  and  passages 
continue,  he  administers  opium,  either  alone  or  with 
bismuth  or  bicarbonate  of  sodium.  In  the  diarrhoea 
of  young  children  which  commonly  occurs  in  hot 
weather,  he  finds  that  the  mildest  of  these  cases 
hardly  need  any  treatment  at  all ;  or  he  sometimes 
gives : 

$.    Ol.  ricini      .         .         .         .          3i-§ss. 
Tinct.  opii    ....        gtt.  ii-iv. 

M.    Sig.  Dose,  according  to  age. 

Should  the  attack  continue,  he  then  considers  it 
unwise  to  use  purgatives.  The  indication  is  to  re- 
lieve the  irritant  condition  of  the  intestine,  to  ac- 
complish which  he  administers  opium,  as  above,  in 
very  small  doses,  generally  using  Dover's  powder  or 
paregoric.  This,  also,  he  finds  is  best  combined  with 
small  doses  of  ipecac,  or  rhubarb,  thus  : 

]jfc.    Tinct.  opii        ....  gtt.  iii-iv. 
Pulv.  ipecac gr.  -J-. 

M.    Sig.  Dose,  every  three  or  four  hours. 

Qr,pulv.  rhei,  gr.  %  is  given  instead  of  the  ipecac. 
He  further  directs  that  the  child  be  kept  quiet  and 
in  a  cool  place,  avoiding  fruits  and  feeding  on  milk 
and  starches. 

The  following  mixture  is  found  by  many  to  be  a 


Il6  DIARRHOEA. 

valuable  prescription  in  cases  of  non-inflammatory 
diarrhoea,  where  there  is  not  much  pain  or  tenesmus, 
and  where  the  evacuations,  though  watery,  are  fecal 
and  contain  but  little  mucus: 

$.    Magnes.  sulph 3  i. 

Tinct.  rhei 3  ii- 

Syrup,  zingib 3  i- 

Aquae  carui  .         .         .         .         3  x. 

M.    Sig.  A  teaspoonful  three   times  daily,  to   a 
child  of  one  year. 

At  the  INFANTS'  HOSPITAL  the  following  is  very 
considerably  employed : 

];&.  Bismuthi  subcarb.  .  .  .  gr.  ii. 
Acidi  tannici  ....  gr.  i. 
Pulv.  ipecac,  co.  gr.  ^. 

M.    Sig.  Dose,  repeated  as  necessary. 
At  the  HART'S  ISLAND  HOSPITAL  (child's),  the 
following  diarrhoea  mixture  is   kept  constantly  on 
hand,  and  is  considered  to  be  a  most  excellent  com- 
bination : 

];&.    Tinct.  capsici        .         .        .        .         §i. 
Tinct.  catechu      .... 
Tinct.  kino  .... 

Tinct.  krameriae  .         .         .         .    aa  §  iv. 

Tinct.  opii §  iii. 

Spts.  menth.  pip.          .         .         .         3  ii. 


DIARRIICEA.  II/ 

Spts.  camphorae  .... 

Aquae aa  ^  iv. 

M.    Dose  :  M.  xxx. 

At  BELLEVUE  HOSPITAL,  the  following  are  used 
with  much  satisfaction : 
JJ.    Tinct.  opii  camph. 

Syrup,  rhei  arom.  .         .         .  aa  §  ss. 

Aquae  calcis  .         .         .         .        §  ii. 

M.    Dose :  A  teaspoonful. 
Or: 
fy.    Hydrarg.  cum  cretae          .         .       gr.  #. 

Pulv.  bismuth,  subnit. 

Pulv.  pepsin aa  gr.iii. 

M.    Sig.  Dose. 

Also: 

5&.    Tinct.  opii  ..... 

Tinct.  rhei  arom. 

Spts.  camphorae          .         .         .     aa3ss. 

Tinct.  cardam.  co.  3  ii. 

Aquae  anisi  q.s.  ad  .         .          ^  iv. 

M.    Dose  :  A  teaspoonful. 

For  the  administration  of  castor  oil,  the  following 
combination  is  rendered  exceedingly 'palatable,  and 
is  readily  taken  by  children  : 

$.    Pulv.  gum.  acac.  .         .         .  §  i. 

Syrupi 

Glycerinae aa  §  i. 


Il8  INTESTINAL   CATARRH. 

Aquae §  iii. 

Ol.  ricini      .         .         .         .         .  §  vi. 
Ext.  vanillse        .... 

Spts.  vini  gall aa  3  ii. 

Ol.  cinnam.  ver.          .         .         .  m.v. 

M.    Dose:  Double  the  quantity  of  oil  intended  to 
be  given. 


INTESTINAL  CATARRH. 


In  cases  of  diarrhoea  with  intestinal  catarrh  in  in- 
fants, when  due  to  improper  food  which  has  not  been 
digested  and  thus  acts  as  an  irritant,  DR.  A.  JACOBI 
places  the  child  on  a  diet  of  milk,  diluted  one-half  or 
less  with  gum  arabic  water,  or  barley  water.  This 
dilution  he  considers  very  important  in  the  treat- 
ment. Also,  to  prevent  coagulation  of  the  milk  by 
the  over-acid  stomach,  he  adds  an  antacid  ;  avoiding 
the  sodium  and  magnesium  salts,  on  account  of  their 
purgative  action,  and  giving  calcium  carbonate  in 
doses  of gr.  iii.  In  some  instances,  and  especially  in 
bad  cases  occurring  in  the  summer  time,  he  finds 
that  cow's  milk  is  not  digested  at  all.  He  therefore 
prohibits  its  use  at  once,  and  gives  barley  water 
alone,  or  substitutes  the  white  of  egg  for  the  milk. 


INTESTINAL   CATARRH.  119 

Or,  if  the  diarrhoea  is  very  marked,  he  forbids  the 
milk  altogether.  This  treatment,  he  advises,  must 
be  kept  up  for  from  one  to  two  weeks,  according  to 
the  previous  duration  of  the  catarrh.  The  diarrhoea, 
he  directs,  should  be  checked  at  once  to  avoid  its 
injurious  effects  on  the  abdominal  glands.  If  there 
is  still  any  irritant  substance  in  the  intestine,  he 
administers  a  dose  of  castor  oil,  3  i-  given  in  hot  milk. 
This  is  usually  efficient. 

For  local  measures,  to  act  on  the  inflamed  mucous 
membrane,  he  considers  bismuth  superior  to  other 
remedies,  as  it  acts  not  only  as  a  protection  to  the 
inflamed  surface,  but  also,  at  the  same  time,  as  an 
anti-fermentative.  He  generally  gives  it  in  combi- 
nation with  opium,  to  check  the  undue  amount  of 
secretion  and  peristaltic  action  ;  thus  : 

IjJL    Bismuthi  subnit.         .         .  gr.  ii-iii. 

Pulv.  Doveri.      .         .         .  gr.  \. 

M.    Sig.     Dose,  every  three  hours. 

Under  this  treatment,  with  careful  attention  to 
feeding,  which  he  considers  most  important,  the 
results  are  usually  very  satisfactory. 

When  the  diarrhoea  is  associated  with  chronic 
catarrh  dependent  upon  ulceration  of  the  intestine, 
DR.  JACOBI  advises  that  treatment  with  astringents 
only  is  useless.  In  these  cases  the  indications  are  to 
stop  the  diarrhoea,  and  heal  the  ulcerations.  Lime 


I2O  INTESTINAL.  CATARRH. 

has  the  effect  of  neutralizing  the  abnormal,  and  per- 
haps the  normal  acids,  and  now  and  then  he  finds 
that  it  does  good  ;  but  if  given  for  a  long  time  it  is 
apt  to  cause  obstinate  constipation,  hence  care  is 
advised  as  to  the  amount  used.  Bismuth,  which 
acts  as  an  anti-fermentative,  he  considers  very  ser- 
viceable. In  children  of  six  to  twelve  months  of  age, 
he  gives: 

]pL    Bismuthi          .         .         .  gr.  ii-iii. 

OP"  •     g- 

M.    Sig.     Dose,  every  three  hours. 

In  some  instances  he  also  prescribes : 

#.    Argenti  nitrat.  .    gr. 

Aquae 3  i. 

M.    Sig.     Dose,  every  two  hours. 

Care  must  be  exercised  about  giving  astringents, 
as  these  young  children  must  also  take  milk. 

As  regards  the  diet,  this  he  believes  to  be  a  matter 
of  the  greatest  importance.  In  many  cases  where 
milk  cannot  be  digested,  he  advises  that  the  patient 
be  made  to  eat  the  milk  by  spoonfuls,  not  to  drink 
it ;  and  to  add  to  it  a  little  common  salt,  as  by  this 
means  it  is  made  more  like  mother's  milk  which 
contains  more  sodium  than  cow's  milk.  When, 
however,  cow's  milk  cannot  be  tolerated  at  all,  he 
directs  that  it  be  mixed  with  some  glutinous  sub- 
stance, so  that  it  can  be  acted  on  very  slowly  by  the 


INTESTINAL  CATARRH.  121 

gastric  acids ;  usually  ordering  one-third  to  one-tenth 
of  cow's  milk,  after  having  boiled  it,  to  be  mixed 
with  barley  water,  the  latter  also  being  boiled  alone 
for  twenty  minutes.  If  cheesy  matter  is  still  found 
in  the  passages,  he  omits  the  milk  altogether,  and 
gives  one  or  two  whites  of  egg  with  barley  water  in 
twenty-four  hours.  On  this  plan,  he  generally  ad- 
ministers about  one-half  pint  of  milk,  three  pints  of 
barley  water,  one  white  of  egg,  and  with  this  a  tea- 
spoonful  of  brandy,  during  the  twenty-four  hours. 

In  cases  of  protracted  diarrhoea  with  chronic  rectal 
catarrh,  where  prolapsus  occurs  after  every  act  of 
defecation,  and  the  mucous  membrane  is  swollen 
with  more  or  less  hypertrophy  of  the  part,  DR. 
JACOBI  finds' the  following  ointment  of  rare  service: 

$.    Ext.  nucis  vomicae         .         ..          pars  i. 
Adipis    .         .         .         .         .      part.  xx. 

M. 

Finally,  he  calls  attention  to  the  fact  that  young 
children  with  catarrh  of  the  colon  and  follicular 
colitis,  are  very  apt  to  have  a  dilated  colon  ;  and  in 
these  dilated  artificial  diverticula  masses  of  fecal 
matter  are  retained,  the  serum  is  absorbed,  and  in 
this  way  the  hard  feces  form,  resulting,  after  a  time, 
in  paralysis  of  the  colon  and  perhaps  of  the  rectum 
and  sphincter. 

DR.  J.  LEWIS  SMITH  prescribes  the  following  with 


122  INTESTINAL   CATARRH. 

much  satisfaction,  in  the  intestinal  catarrh  of  infants 
where  the  nausea  is  extreme : 

Ijfc.    Acidi  carbol gtt.  ii. 

Aquae  calcis          .         .         .         .         §  ii. 

M.    Sig.     A  teaspoonful. 

This  he  directs  should  be  taken  with  a  teaspoonful 
of  milk,  using  breast  milk  if  the  baby  nurses,  and 
repeated  as  often  as  the  nausea  requires.  Where  the 
disease  has  passed  into  the  chronic  stage,  he  admin- 
isters tonics,  etc.,  and  advises  the  most  careful  atten- 
tion to  feeding  and  hygiene.  For  a  tonic  in 
these  cases  he  gives  the  following  with  marked  ben- 
efit: 

^.    Tinct'.  calumbae        .         .         .  3  iii- 

Liq.  ferri  nitratis       .         .         .  gtt.  xxvii. 
Syrup,  simplic.          .         .         .         .  §  in. 

M.  Sig.  A  teaspoonful  every  four  hours,  to  an 
infant  of  one  year. 

This  he  finds  especially  valuable  where  there  is 
much  pallor,  loss  of  strength,  and  emaciation,  show- 
ing failure  of  the  vital  powers. 

In  cases  of  diarrhoea  where  no  history  of  weather 
influences  exists,  and  with  vomiting  and  considerable 
fever,  DR.  F.  DELAFIELD  gives  sedatives  at  once, 
using  opium  either  alone  or  with  bismuth,  ipecac,  or 
sodii  bicarb.  ;  often  prescribing  the  following: 

IJfc.    Pulv.  Doveri        ...  gr.  ss-i. 


INTESTINAL   CATARRH.  123 

Bismuthi  subnit.          .        .         gr.  iii-iv. 

M.    Sig.     Dose,  every  three  or  four  hours. 

Or,  ipecac,  gr.  \,  or  rhei,  gr.  £,  is  sometimes  substi- 
tuted for  the  bismuth  in  the  above  combination.  In 
some  instances,  however,  where  although  the  child 
improves,  yet  it  does  not  entirely  recover,  and  the 
disease  becomes  protracted,  he  advises  that  it  is  use- 
less to  persist  with  the  opium  treatment  after  a 
moderate  time.  In  these  cases  he  directs  that  a 
change  of  air  be  obtained,  which  alone  will  often 
effect  a  cure.  Where  this  is  not  sufficient,  he  then 
administers  hydrarg.  cum  cretce,  gr.ss.  two  or  three 
times  daily,  for  three  or  four  days,  and  usually  with 
very  marked  benefit.  Or,  he  frequently  gives  calo- 
mel gr.  \-ss.  in  the  same  manner. 

Regarding  diet  in  these  protracted  cases,  if  the 
child  is  nursing  he  sometimes  allows  it  to  continue, 
or  may  change  the  nurse,  or  try  hand-feeding ;  vary- 
ing his  course  with  the  indications.  If  the  child  is 
fed  with  the  bottle  he  generally  changes  the  food, 
sometimes  adding  other  articles,  where  the  diet  has 
been  milk  alone,  or,  in  other  instances,  directing  that 
the  child  be  nursed.  In  other  children,  he  usually 
obtains  good  results  from  feeding  on  raw  meat,  beef- 
steak scraped  to  a  pulp,  with  a  little  salt  added,  and 
keeping  this  up  for  some  time  (avoiding  a  too  long 
continuance,  however,  from  danger  of  scurvy). 


124  INTESTINAL   CATARRH. 

In  the  severest  forms  of  the  disease,  where  although 
the  attack  begins  in  a  mild  way,  yet  in  spite  of  treat- 
ment the  diarrhoea  continues,  assuming  a  dysenteric 
character,  and  the  stools  finally  become  of  a  starchy 
consistency,  a  whitish  color,  and  at  the  same  time 
more  and  more  abundant,  while  the  constitutional 
symptoms  are  extremely  marked  and  emaciation 
rapid,  DR.  DELAFIELD  proceeds  as  follows :  In  the 
milder  forms  he  generally  finds  it  best  to  commence 
with  castor  oil,  thus : 

IjL    Ol.  ricini        .         .         .         .       3i~3ss. 
Tinct.  opii      ....     gtt.  ii-iv. 

M.    Sig.     Dose,  according  to  age. 

This,  in  some  cases,  maybe  sufficient.  Should  the 
movements  continue  for  a  time,  he  then  administers 
opium  with  bismuth,  as  in  other  instances.  If  the 
disease  still  persists,  the  remedies  which  he  finds 
most  serviceable  are  the  mineral  acids,  with  opium  ; 
more  especially  dilute  hydrochloric  acid,  which  he 
administers,  at  first,  as  follows: 

$.    Acid,  hydrochlor.  dil.         .         gtt.  x-xx. 
Tinct.  opii          ....    gtt.  i-ii. 

M.  Sig.  Dose,  three  or  four  times  daily,  accord- 
ing to  age. 

As  improvement  takes  place,  he  diminishes  the 
opium,  keeping  on  with  the  acid,  until  the  child  is 


INTESTINAL   CATARRH.  125 

much  better,  when  he  stops  the  opium  altogether, 
the  acid,  however,  being  still  continued. 

For  the  diet,  in  these  cases,  DR.  DELAFIELD  finds 
that  these  children  are  best  fed  with  cod  liver  oil  and 
meat,  and  with  as  little  starch  as  possible ;  older 
children  he  places  on  a  diet  of  cream  and  milk  with 
meat  or  oil,  while  to  very  young  children  he  gives 
cream  and  milk.  If  possible,  he  advises  a  change  of  air, 
as  exceedingly  beneficial,  except  in  chronic  cases.  He 
also  advises  care  in  regard  to  the  general  manage- 
ment of  the  child,  regulating  the  bath,  clothing,  etc. 

DR.  A.  A.  SMITH  often  gives  the  following  with 
advantage,  in  those  cases  where  the  diarrhoea  is  ac- 
companied by  mucous  passages,  showing  a  slight 
degree  of  inflammation : 

Tfr.     Hydrarg.  bichloridi          .         .          gr.  £. 
Aquae      .....          §  viii. 

M.    Sig.     A  teaspoonful  every  hour. 

Where  a  more  intense  inflammatory  action  is 
present,  with  straining,  and  the  passages  consist  of  a 
jelly  looking  matter,  but  not  truly  dysenteric,  he 
prescribes  the  following  very  effectually  : 

~fy.    Ol.  ricini         .-        .         .         .          gtt.  v. 
Sacchari          .... 
Mucilag.          .... 
Aquae     .         .         .         .         .        aa  q.  s. 

M.    Sig.     Dose,  every  hour. 


126  DYSENTERY. 

This  remedy,  thus  administered,  he  has  found  to 
render  excellent  service  in  many  of  these  cases. 

At  BELLEVUE  HOSPITAL  the  following  form  of 
combination  for  Dover's  powder  is  very  much  used, 
and  is  considered  preferable  to  the  officinal  powder : 
]jfc.    Pulv.  opii  (12  per  cent.) 

Pulv.  ipecac.  aa  gr.  i. 

Sacchari  lactis  gr.  viii. 

M. 


DYSENTERY. 


In  catarrhal  dysentery,  DR.  FRANCIS  DELAFIELD 
considers  rest  all  important ;  no  matter  if  the  con- 
stitutional symptoms  are  slight,  or  even  absent,  still 
he  insists  on  the  necessity  of  absolute  rest.  In  milder 
cases  this  may  be  all  that  is  necessary,  and  the  dis- 
ease succumbs  without  further  treatment.  If  seen 
early  he  usually  begins  with  : 

9.    Ol.  ricini        ....  3  i-iii. 

Tinct.  opii      ....      gtt.  iii-v. 

M.    Sig.     Dose. 

Where,  however,  the  pain  and  irritation  about  the 
rectum  continue,  opium  is  given  to  control  it ;  either 
by  the  mouth  in  the  form  of  bismuth  and  opium 
powders,  or  by  the  rectum  in  small  enemata  of 


DYSENTERY.  12? 

starch  and  laudanum,  or  by  suppositories.  Regarding 
diet,  this,  he  advises,  needs  careful  regulation  ;  all  solid 
food  must  be  avoided  and  the  child  fed  on  milk,  either 
alone  or  with  starches,  arrowroot,  rice,  etc.  By  this 
means,  these  cases  usually  terminate  favorably. 

In  croupous  dysentery,  if  the  case  is  seen  at  the 
onset,  and  in  those  resembling  the  catarrhal  form, 
he  generally  administers  ol.  ricini  and  opium  in  suffi- 
cient doses  to  afford  quiet  and  relieve  the  pain. 
After  the  first  dose  he  often  finds  it  necessary  to  give 
only  the  opium.  In  the  more  severe  forms,  however, 
after  beginning  with  castor  oil  and  opium,  he  then 
administers  ipecac  in  large  doses  every  one,  two,  or 
three  hours,  according  to  the  severity  of  the  disease 
and  the  patient ;  at  the  same  time  giving  opium  in 
small  doses.  In  three  or  four  days  he  repeats  the 
castor  oil,  following  it  with  ipecac  as  before,  and  then 
falls  back  on  opium.  During  this  treatment  the  ol. 
ricini  may  have  to  be  repeated  several  times,  depend- 
ing upon  the  duration  of  the  disease.  Where  the 
pulse  becomes  feeble,  stimulants  are  given.  After 
the  inflammatory  process  has  run  its  course,  and 
ulcers  are  present,  the  castor  oil  and  ipecac  are  dis- 
carded, and  the  dilute  mineral  acids  resorted  to  ;  or 
suppositories  of  iodoform  are  used  with  good  effect. 
Stimulants  are  also  employed  at  this  stage,  and  the 
strength  of  the  patient  supported  with  good  nour- 


128  DYSENTERY. 

ishment,  etc.,  the  diet  consisting  of  arrowroot,  rice, 
and  milk. 

Where  the  disease  tends  to  become  protracted, 
DR.  DELAFIELD  advises  especial  care  regarding  rest 
and  diet.  A  strictly  milk  food  he  finds  particularly 
serviceable  in  the  catarrhal  form.  Moderate  stimu- 
lation is  also  employed,  and  a  very  gradual  return 
made  to  the  ordinary  diet.  For  the  general  health, 
he  administers  tonics,  iron  and  quinine,  and  advises  a 
change  of  residence  to  a  warm  climate,  together  with 
plenty  of  fresh  air. 

As  a  rule,  in  most  instances,  DR.  J.  LEWIS  SMITH 
finds  that  marked  improvement  is  often  derived  from 
administering  the  following : 

Ijfc.    Pulv.  ipecac,  co.        .         .         .         .Si- 
Bismuth,  subnit;       .         .         .         .   3  ii. 
M.     Div.  in  pulv.  No.  xxiv. 

Sig.     One  every  two  to  four  hours,  to  a  child 
of  five  years. 

In  conjunction  with  this,  he  also  gives: 
^.    Tinct.  opii  deod.         .         .         .         3ss. 
Bismuthi  subnit.         .        .         .          3  ii. 
Aq.  menth.  pip.          .... 
Syr.  zingib.         .         .         .         .       aa§i. 
M.    Sig.  A  teaspoonful,  every  two  to  four  hours. 
Besides  this  means  of  treatment,  he  directs  that 
the  most  careful  attention  be  paid  to  diet,  etc. 


DYSENTERY.  129 

DR.-  G.  B.  FOWLER  (also  DRS.  A.  H.  SMITH  and 
LORDLY)  has  employed  beef  peptone,  in  cases  of  acute 
dysentery,  with  remarkable  effect.  Under  the  use 
of  this  remedy  the  results  have  been  exceedingly 
good ;  the  distressing  symptoms  subside,  the  vomi- 
ting and  stools  are  speedily  controlled,  nutrition  is 
markedly  improved,  and  the  child  soon  begins  to  re- 
cover its  health  and  strength.  The  administration 
is  usually  commenced  with^YA  x.  of  beef  peptone  every 
two  hours,  and  then  gradually  increased  to  doses  of 
3  i.  every  two  or  three  hours,  to  infants  of  six  months 
and  over.  He  generally  gives  it  in  water,  sufficiently 
diluted,  and  sweetened  to  the  taste.  Should,  how- 
ever, the  strong  taste  of  meat  be  objected  to,  it  is 
often  added  to  a  simple  broth,  and  in  this  way 
readily  taken.  Moreover,  as  a  diet,  in  these  cases, 
he  has  found  peptone  to  be  assimilated  when  all 
other  foods  are  rejected. 

In  older  children,  DR.  ALONZO  CLARK  uses  the 
following  with  much  advantage : 

IJ.    Bismuth,  subnit.         .        .         .        gr.  v. 
Morphiae  sulph.          .         .  gr.  -fa. 

M.    Sig.  Dose,  two  or  three  times  daily. 

By  this  means  he  often  obtains  relief  in  these 
cases ;  advising,  also,  that  the  influence  of  proper 
diet  and  surroundings  must  receive  careful  atten- 
tion. 

9 


I3G  CHOLERA   IXFANTUM. 

At  BELLEVUE  HOSPITAL  the  following  mixture  is 
employed  : 

IjL    Acid,  nitric m.  viii. 

Tinct.  opii      .         .         .         .  m.  xl. 

Aquae  camphor.      ...  §  viii. 

M.  Dose :  A  tablespoonf  ul  or  less,  according  to  age. 


CHOLERA  INFANTUM. 

(SPURIOUS    HYDROCEPHALUS.) 


In  the  earlier  stages  of  the  disease,  DR.  J.  LEWIS 
SMITH  finds  that  the  following  is  often  of  great  ser- 
vice : 

$.    Tinct.  opii  deod.  .        .         gtt.  xvi. 

Bismuth,  subnit.  .        .         .        3  ii- 

Syrupi §  ss. 

Aquae  .  .         .  §  iss- 

M.  Sig.  A  teaspoonful  every  two  or  three  hours, 
to  a  child  of  one  year. 

When  the  vomiting  and  diarrhoea  are  excessive 
and  peristent,  so  that  no  food  is  retained,  he  uses 
the  following  with  marked  benefit : 

Ipfc.    Spts.  ammon.  aromat.      .         .         3ss-i. 
Tinct.  opii         ....     gtt.  xvi. 


CHOLERA   INFANTUM.  13! 

Bismuth,  subnit.      .         .         .  3  ii- 

Mistur.  cretae  ....  §iss. 

Syrupi  simp.  .         .        .  §  ss. 

M.  Sig.  A  teaspoonful  every  two  or  three  hours, 
to  a  child  of  eight  to  twelve  months. 

This  he  continues,  as  directed,  until  these  symp- 
toms are  fully  controlled.  Stimulants  are  also  ad- 
ministered as  required.  When  the  hydrocephaloid 
stage  is  reached,  he  gives  the  following  with  advan- 
tage : 

$.    Tinct.  calumbae         .         .         .  3  ii- 

Liq.  ferri  nitratis      .         .          gtt.  xviii. 
Syrupi §  ii. 

M.    Sig.  A  teaspoonful. 

On  this  plan,  together  with  the  most  careful  at- 
tention to  diet,  etc.,  his  results  are  often  very  favor- 
able. 

At  the  NEW  YORK  FOUNDLING  ASYLUM  the 
hrdrobromide  of  cinchonidia,  by  hypodermic  injec- 
tion, has  been  employed  in  numerous  instances  of 
cholera  infantum,  and  usually  with  the  most  satisfac- 
tory results.  In  many  cases  with  high  temperature, 
and  profuse  diarrhoea  and  vomiting,  this  remedy  has 
afforded  relief  in  a  very  short  time.  The  injection, 
it  is  advised,  should  be  repeated  at  least  once,  if  not 
twice,  in  the  twenty-four  hours.  A  ten  per  cent, 
solution  is  generally  employed,  and  small  doses  of 


132  CHOLERA   INFANTUM. 

carbolic  acid  given  internally  in  conjunction,  with 
also  cold  baths  and  stimulants  as  required.  By  this 
method,  also,  not  only  a  speedy  action  of  the  remedy 
is  obtained,  but  any  disturbance  of  the  stomach  is 
avoided,  as  well  as  a  liability  to  the  production  of 
abscesses,  which  not  infrequently  results  when  quin- 
ine is  employed  in  this  manner.  After  the  vomiting 
has  ceased,  the  good  effects  of  the  remedy  are  main- 
tained by  administering  it  by  the  mouth. 

The  following  case  will  exemplify : 

JULY  29th. — Infant,  two  months  old.  Has 
diarrhoea  and  vomiting ;  sick  twenty-four  hours ; 
passages  green  and  watery ;  vomits  greenish  fluid. 
Temp.  104!°  in  the  rectum.  Administered  sol.  cin- 
cJwnid.  hydrobrom.  (ten  percent.}  m.  viii.  hypodermi- 
cally  over  the  nates.  Ordered,  in  conjunction  with 
the  above,  the  following : 

Ijfc.    Acid,  carbol.  .         .         .         gtt.  \. 

Tinct.  opii  deodor.          .         .         gtt.  f . 
Mist,  cretae     ....  3  i. 

M.     Sig.   Dose,  every  two  hours. 

Cold  baths  given  every  three  hours.  Brandy  and 
toast-water  as  a  drink. 

AUG.  5th. — Bowels  improved.  Vomiting  checked. 
Temp  IO2-|°  in  the  rectum.  Gave  cinchondicz  hydro- 
brom. gr.  i.  four  times  daily,  by  the  mouth.  After- 
ward, the  case  did  well. 


CHOLERA  INFANTUM.  133 

DR.  FRANCIS  DELAFIELD  finds  that  treatment  of 
any  kind  is  very  unsatisfactory.  Regarding  the 
diet,  if  the  child  is  nursing  he  usually  allows  it  to 
continue,  or  in  some  cases  he  may  change  the  nurse, 
or  try  hand  feeding.  Where,  however,  the  child  is 
bottle  fed,  he  sometimes  changes  the  food  or  directs 
that  a  nurse  be  obtained ;  but,  as  a  rule,  he  finds 
that  these  cases  do  better  with  cream  and. water,  or 
wine  whey  in  small  and  very  frequent  doses.  If 
vomiting  is  excessive  so  that  all  nourishment  is  re- 
jected, inunctions  of  oil,  olive  or  cod  liver,  are  re- 
sorted to  very  effectually  when  other  means  fail. 

For  internal  medication  he  knows  of  no 
remedy  which,  in  his  experience,  has  any  very  de- 
cided effect  on  the  disease.  Opium  is  given  in  small 
doses,  and  though  it  may  not  have  much  effect  in 
checking  the  disease,  yet  it  is  of  service  in  allaying 
the  irritation  of  the  child.  In  some  cases  he  finds 
that  calomel  in  doses  of  gr.  ^-i.  three  or  four  times 
daily,  according  to  age,  or  mercury  with  chalk  simi- 
larly given,  seems  to  be  very  serviceable  in  checking 
the  disease.  In  others,  ol.  ricini  is  given,  not  to  act 
as  a  purge,  but  in  small  and  frequent  doses,  a  few 
drops  in  emulsion  every  three  or  four  hours,  and 
often  seems  to  act  very  beneficially.  Other  remedies, 
such  as  the  preparations  of  bismuth,  dilute  hydro- 
chloric acid,  or  dilute  sulphuric  acid,  are  also  used  in 


134  CONSTIPATION. 

different  instances.  DR.  DELAFIELD  considers  it 
best,  however,  in  all  cases  of  cholera  infantum,  to 
send  the  child  to  some  other  climate,  and  the  earlier 
the  better.  Nor  in  this  respect,  he  advises,  should 
there  be  any  hesitation,  even  through  prostration  is 
so  great  that  the  child  is  apparently  moribund. 

After  the  acute  symptoms  of  the  disease  have  sub- 
sided, the  following  combination  is  often  found  re- 
markably beneficial : 

T$.    Argenti  nitrat gr.i. 

Acid,  nitric,  dil.  .         .         .     m.viii. 

Tinct.  opii  deodor.      .         .         .     m.viii. 

Mucilag.  acaciae          .         .         .         §  ss. 

Syrup,  simp.       .         .         .         .          §  ss. 

Aquae  cinnamomi        .        .         .  §  i. 

M.  Sig.  A  teaspoonful  every  three  to  six  hours, 
to  a  child  of  one  year. 


CONSTIPATION. 


DR.  A.  JACOBI  finds  that  young  children  with  ca- 
tarrh of  the  colon  and  follicular  colitis,  are  very  apt 
to  have  a  dilated  colon  ;  and  in  these  dilated  arti- 
ficial diverticula  masses  of  fecal  matter  are  retained, 


CONSTIPATION.  135 

the  serum  is  absorbed  and  in  this  way  the  hard  feces 
form,  resulting  after  a  time  in  paralysis  of  the  colon 
and  perhaps  of  the  rectum  and  sphincter.  In  such 
cases  of  constipation,  with  paralysis  of  the  sphincter 
ani  and  incontinence  of  feces,  the  discharges  being 
hard  and  black,  where  no  abnormal  irritability  of  the 
intestine  exists,  he  directs  his  treatment  toward  re- 
storing the  power  of  the  sphincter.  The  general 
measures  adopted  by  him,  consist  in  the  administra- 
tion of  nerve  stimulants  and  tonics,  such  as  strychnia. 
Locally,  he  resorts  to  the  use  of  strychnia,  applying 
after  each  act  of  defecation  an  ointment  of  the  fol- 
lowing; 

R.    Ext.  nucis  vomicae     .         .  gr.  xii. 

Adipis       .....      3  iii-iv. 

M. 

Or,  he  often  uses  the  sulphate  of  strychnia  hypo- 
dermically,  thus : 

IjL    Strychniae  sulph.          .  •   .      gr.g1,,. 

Aquae           .         .         .         .         .          q.s. 

M.     Sig.     To  be  injected  once  daily. 

He  also  employs  the  galvanic  and  faradic  currents, 
using  them  alternately  once  a  day.  In  addition  to 
these  means  of  treatment,  he  directs  that  injections 
of  cold  water  be  administed  twice  daily. 

Regarding  the  diet,  if  there  is  also  intestinal  ca- 
tarrh present,  this  is  considered  of  the  greatest  im- 


136  CONSTIPATION. 

portance.  When  milk  is  poorly  digested,  or  not  all, 
he  directs  that  a  little  salt  be  added  and  the  child  be 
made  to  eat  the  milk,  a  spoonful  at  a  time,  instead 
of  drinking  it.  Should  even  this  be  rejected,  he  finds 
that  it  may  be  retained  by  adding  to  the  milk  some 
glutinous  substance,  thus  causing  it  to  be  acted  upon 
very  slowly  by  the  gastric  acids.  In  such  cases,  he 
usually  gives  very  successfully  a  mixture  of  one-third 
to  one-tenth  of  cow's  milk,  previously  boiled,  with 
oatmeal  water,  after  boiling  the  latter  alone  for  twenty 
minutes. 

DR.  JACOBI  also  calls  attention  to  the  fact  that  the 
size  of  the  colon  and  its  sigmoid  flexure,  as  \vell  as 
the  number  of  its  flexures,  does  not  obtain  its  nor- 
mal relation  until  from  the  fifth  to  the  eighth  year  of 
life.  In  these  flexures  accumulations  of  feces  often 
take  place.  Where  this  state  of  things  exists,  the 
secretion  of  the  intestine  is  usually  insufficient,  caus- 
ing a  dryness  of  the  feces  resulting  in  constipation. 
Therefore  constipation  depending  upon  an  abnormal 
length  of  the  sigmoid  flexure,  and  the  presence  of  a 
number  of  flexures,  will  wear  off,  and  is  not  amenable 
to  treatment  by  purgatives,  which,  if  used,  may  cause 
a  paralysis  of  the  sphincter ;  hence  he  advises  that 
these  should  never  be  employed  except  in  very  urgent 
cases.  When  such  a  condition  is  suspected,  he  reg- 
ulates the  diet  so  that  there  may  be  an  abundance  of 


WORMS.  137 

water  in  the  food.  For  a  food,  he  gives  oatmeal  in 
preference  to  any  other.  His  main  treatment,  how- 
ever, in  these  cases,  consists  in  the  regular  daily  use 
of  injections  into  the  bowels.  These,  he  advises,  are 
highly  beneficial,  but  may  have  to  be  qontinued  for 
many  months  ;  as  the  constipation,  being  anatomical, 
may  not  disappear  until  the  cause  is  removed.  He 
directs,  therefore,  that  the  intestine  be  washed  out 
with  simple  warm  water,  day  after  day,  while  waiting 
for  nature  to  restore  the  proper  proportion  of  the  in- 
testinal canal.  In  obstinate  cases  he  sometimes  re- 
sorts to  the  use  of  the  scoop. 

DR.  A.  A.  SMITH  recommends  the  following  very 
highly,  in  cases  of  constipation  in  children,  as  an  ex- 
ceedingly pleasant  and  efficacious  laxative : 

9,.    Ext.  rhamni  frangulae  fl.        .         •          §i. 
Aquae  menth.  pip.         .         .         .          §  i. 

M.  Sig.  One  to  two  teaspoonfuls,  to  a  child  from 
two  to  eight  years  of  age. 


WORMS. 


For  the   expulsion    of   the   round  worm,   DR.    J. 
LEWIS  SMITH  uses  the  following  very  effectually : 


138  WORMS. 

]jL    Ext.  spigeliae  fl §  i. 

Ext.  sennae  fl.  .         .  §  ss. 

M.  Sig.  A  teaspoonful,  to  a  child  of  three  to 
five  years. 

Or,  in  marly  cases  he  prefers  to  give  the  following, 
which  he  considers  equally  serviceable  : 

Ufa.     Ext.  spigeliae  et  sennae  fl.     .         .          3  i. 
Santonini gr.  viii. 

M.     Sig.     A  teaspoonful,  to  a  child  of  five  years. 

Moreover,  he  finds  that  these  prescriptions  are  also 
an  effectual  means  of  destroying  the  ascaris  vermicu- 
laris. 

For  the  removal  of  the  t&nia  solium,  DR.  SMITH 
often  uses  the  ethereal  extract  of  male  fern  with  ex- 
cellent results.  In  many  instances  he  administers  : 

IJ.    Ext.  filicis  mar.  aether.          .         .         3  i. 
Sig.  Dose,  to  a  child  of  four  years. 

This  amount  he  is  in  the  habit  of  giving  to  these 
young  children,  and  has  never  seen  any  bad  effects 
follow.  In  regard  to  the  frequent  failure  in  efficacy 
of  this  drug  in  taenia,  he  believes  this  is  due  to  the 
fact  that  the  dose  prescribed  was  not  large  enough, 
and  the  patient  had  not  been  previously  put  upon 
the  preparatory  treatment  which  is  so  essential. 

DR.  A.  JACOBI  advises  that  in  many  cases  the 
taenia  found  in  very  young  children  is  the  tcznia 
medio-canellata,  caused  by  feeding  the  child  with  raw 


WORMS.  139 

meat  as  a  remedy  for  diarrhoea ;  and  finds  that  their 
expulsion  is  far  more  difficult  than  of  the  taenia  so- 
lium  in  adults.  To  accomplish  this,  he  administers 
kameela  powder,  3  i>  in  the  course  of  tivo  hours.  Or, 
sometimes  he  prescribes  kousso  with  good  effect. 
Previous  to  this,  however,  he  directs  that  the  child 
be  fed  on  oatmeal  and  milk,  and  purged  three  or  four 
times  daily.  Then,  after  the  administration  of  the 
kameela,  a  little  milk  is  given,  and  if  the  worm  does 
not  appear  in  an  hour,  he  orders  a  dose  of  castor  oil. 
In  his  experience  this  plan  is  usually  very  success- 
ful. 

DR.  VAN  GIESEN  has  found  the  aspidium  margi- 
nale — the  indigenous  congener  of  the  male  fern — 
very  serviceable  in  causing  discharge  of  the  worm, 
and  generally  in  a  short  time.  This  he  gives  as  fol- 
lows : 

~ty.     Ext.aspidiimarginal.fi.     .         .          3  H. 
Olei  olivae  .        .         .        .        3  iv. 

^Ether.  sulphuric.         .        .         .        3  ss. 

M.  Sig.  Half  a  teaspoonful  every  fifteen  min- 
utes. 

After  three  or  four  doses  have  been  taken,  he  ad- 
ministers a  purge  of  castor  oil.  This  remedy,  he 
thinks,  in  not  a  few  instances,  has  undoubtedly  done  as 
well  as  the  male  fern  usually  does.  In  a  great  many 
cases,  however,  he  also  uses  the  ethereal  extract  of 


I4O  INCONTINENCE   OF   URINE. 

filix  mas  in  doses  of  m.  xxx.  to  a  child  of  two  years. 
This  amount  he  gives  very  effectually,  and  without 
any  bad  results. 


INCONTINENCE  OF  URINE. 


At  BELLEVUE  HOSPITAL  the  combination  of  ergot, 
belladonna,  and  iodide  of  iron  is  employed  in  a  large 
number  of  cases,  and  proves  more  successful  for  the 
incontinence  of  urine  in  children  than  either  of  the 
drugs  alone,  or  than  any  other  combination  which 
has  been  tried. 

In  many  cases  the  following  is  often  found  to  be 
of  excellent  service,  affording  speedy  relief  to  the  ir- 
ritability of  the  bladder : 

$.    Strychniae  .         .         .         .         gr.  i. 

Pulv.  cantharides  gr.  ii. 

Morphiae  sulph.  .         .  gr.  iss. 

Ferri  pulv.  .         .         .         .  $1. 

M.    Ft.  pil.  No.  xl. 

Sig.  One,  three  times   a   day,  to   a   child  of 
ten  years. 

In  conjunction  with  the  above,  a  cold  shower  bath 
is  usually  given  daily,  and  careful  attention  paid  to 


INFANTILE   LEUCORRHCEA.  141 

the  avoidance  of  irritant  food  and  late  suppers.  The 
child  should  also  be  made  to  lie  on  the  side  or  belly, 
taking  care  to  drink  nothing  for  a  few  hours  pre- 
ceding sleep,  and  to  empty  the  bladder  thoroughly 
before  going  to  bed. 


INFANTILE   LEUCORRHCEA. 


DR.  T.  GAILLARD  THOMAS  considers  it  of  pri- 
mary importance  to  ascertain  if  worms,  usually  the 
ascaris  vermicularis,  are  present ;  and  if  so,  or  should 
they  be  suspected,  he  uses  an  injection  of  warm  salt 
water.  He  then  endeavors  to  build  up  the  general 
nutrition  of  the  child,  and  place  it  in  the  best  pos- 
sible condition,  by  appropriate  food,  iron,  vegetable 
tonics,  and  the  administration  of  the  hypophosphites. 
He  places  more  dependence,  however,  upon  a  good 
nourishing  diet  than  upon  medicines.  After  the  ex- 
pulsion of  the  worms,  should  the  irritation  and  dis- 
charge continue,  or  even  if  no  worms  have  been 
present,  he  then  resorts  to  local  measures.  Placing 
the  child  upon  the  back  in  order  that  the  canal  may 
be  perfectly  cleansed,  he  washes  out  the  vagina 
thoroughly,  by  means  of  a  syringe  provided  with  a 


142  INFANTILE   LEUCORKHCEA. 

small  nozzle  which  has  been  previously  well  oiled. 
In  many  instances,  he  finds  that  the  mere  removal 
of  the  accumulated  secretion,  which  is  a  constant 
source  of  irritation,  is  all  that  is  required.  Where, 
however,  the  trouble  has  lasted  for  some  time,  this 
is  not  always  sufficient.  In  such  cases  he  uses  the 
old-fashioned  black  wash,  as  follows : 

IjL    Hydrarg.  chlor.  mit.         .         .          3  ss-i. 
Aquse  calcis     .....     Oi. 

M.    Sig.     To  be  applied  twice  daily. 

This  he  believes  to  be  one  of  the  best  applications 
that  can  be  employed.  Before  using  it,  an  injection 
of  simple  warm  water  is  made. 

Under  this  treatment,  DR.  THOMAS  has  never 
failed  to  cure  infantile  leucorrhoea  in  a  short  time ; 
therefore  he  advises  against  any  necessity  of  resort- 
ing to  astringents  and  silver  nitrate,  which  may  do 
harm.  He  also  directs  that  the  mother  or  nurse  be 
instructed  how  to  properly  introduce  the  nozzle  of 
the  syringe,  otherwise  it  is  seldom  carried  far  enough 
up  into  the  vagina,  while  it  should  reach  the 
upper  part,  and  improvement  will  fail  to  follow  its 
use. 

DR.  J.  B.  HUNTER  generally  finds  constitutional 
treatment  and  bathing  of  the  external  genitals  suffi- 
cient. As  a  final  resort,  he  recommends  injections. 
In  this  respect,  however,  he  objects  to  cold  water 


INFANTILE    LEUCORRHCEA.  143 

injections  as  injurious,  having  on  many  occasions 
seen  bad  results  from  their  use. 

DR.  V.  P.  GIBNEY  has  frequently  met  with  cases 
of  sero-purulent  vaginal  discharge,  in  children  of  two 
to  six  years  of  age.  In  some  instances  he  places  the 
child  upon  the  following,  with  much  advantage : 

1), .    Calcii  sulphidi         ...          gr.  -^ 
Sig.     Dose,  every  three  hours. 

If  no  benefit  obtains  in  a  few  days,  he  orders  warm 
and  slightly  carbolized  injections.  When  indicated, 
he  also  prescribes  iron  and  cod  liver  oil.  Sometimes 
he  finds  this  plan  is  very  serviceable,  while  at  others 
no  benefit  at  all  is  apparently  derived. 

DR.  BEVERLY  ROBINSON  is  not  inclined  to  ascribe 
so  much  importance  to  the  condition  of  diathesis,  in 
cases  of  leucorrhoea  in  children.  Local  treatment  is 
considered  by  him  as  generally  much  more  effectual. 
Moreover,  in  the  treatment  of  vaginitis  by  injections, 
he  thinks  that  cold  injections  probably  have  an  ad- 
vantage over  warm  ones. 

At  the  NEW  YORK  HOSPITAL  this  condition  is 
found  to  be  not  infrequently  associated  with  a 
strumous  diathesis;  or,  occasionally  the  urine  ex- 
hibits the  presence  of  a  large  amount  of  uric  acid. 
In  some  of  these  cases  local  measures  are  adopted, 
although  the  propriety  of  this  treatment  is  consid- 
ered as  doubtful. 


PART  IV. 

DISEASES  OF  THE  BRAIN  AND 
NERVOUS  SYSTEM. 


CONVULSIONS. 


DR.  J.  LEWIS  SMITH  considers  the  treatment  of 
infantile  convulsions  one  of  the  greatest  importance, 
as  these  cases  are  so  frequently  met  with  without 
being  able  first  to  ascertain  the  cause.  Ordinarily, 
regarding  the  seat  of  the  disturbance  as  being  in  the 
intestine — either  overloading  or  indigestible  food — 
he  first  causes  evacuation  of  the  bowels.  For  the 
convulsion  itself,  when  occurring  in  infants  and  de- 
pendent upon  pain  produced  by  the  irruption  of  the 
teeth,  he  rarely  or  never  uses  the  gum  lancet.  His 
reliance  is  almost  wholly  upon  the  bromides,  prefer- 
ring the  potassium  salt  in  large  and  frequent  doses, 
thus: 

5>.    Potass,  bromidi         .         .         .     gr.  ii-vi. 


CONVULSIONS.  145 

Aquae q.  s. 

M.  Sig.  Dose,  every  ten,  fifteen,  or  twenty  min- 
utes, to  a  child  between  two  and  twelve  months  of 
age. 

This  he  repeats  as  above,  according  to  the  severity 
of  the  case  and  to  the  control  of  the  irritation,  and 
he  has  never  seen  any  bad  results  follow  from  this 
course. 

In  the  convulsions  of  children,  his  plan  is  to  give 
chloral  hydrate  by  rectal  injection,  combined  with 
the  internal  use  of  the  bromide,  and  if  the  spasms 
are  not  soon  controlled  he  administers  chloral  hypo- 
dermically.  He  usually  prescribes  the  following: 

Ijfc.    Chloral,  hydrat 3i. 

Aquse §  iss. 

M.  Sig.  3  i.  (gr.  v.)  every  five  or  ten  minutes,  as 
an  enema. 

By  this  treatment,  if  retained,  he  finds  that  the 
beneficial  effect  of  the  drug  is  often  surprisingly 
shown,  and  its  action  readily  and  speedily  exhibited. 
The  convulsive  movements  are  controlled  in  the 
shortest  possible  time,  generally  within  twenty 
minutes,  and  in  many  cases  in  even  a  shorter  period. 
He  then  continues  the  treatment  with  the  bromide, 
if  necessary.  As  to  the  administration  of  anaesthet- 
ics, that  is  to  say  of  chloroform,  DR.  SMITH  never 
resorts  to  this  agent.  He  altogether  prefers  cJiloral 


146  CONVULSIONS. 

hydrate,  thus  not  only  avoiding  the  danger  of  para- 
lyzing the  respiratory  center,  but  also  of  being  com- 
pelled to  remain  three  or  four  hours  with  the  patient. 
Concerning  the  hot  bath,  he  often  finds  it  an  exceed- 
ingly useful  adjunct.  In  cases,  so  frequently  met 
with,  where  convulsions  are  threatened,  with  sudden 
twitching,  starting,  etc.,  and  especially  if  the  hand  is 
affected  or  the  thumb  turned  in,  he  has  repeatedly 
found  that  by  placing  the  child  in  a  tepid  bath  of 
100°,  a  soothing  effect  is  obtained  and  sleep  often 
induced  after  its  use.  The  hot  bath,  however,  may 
in  some  instances,  be  too  stimulating,  but  he  finds 
no  objection  in  applying  it  to  the  extremities,  as  in 
the  majority  of  cases  active  or  passive  cerebral  con- 
gestion is  present,  which  may  be  thus  relieved. 

In  cases  of  convulsions,  reflex  in  character  and 
dependent  upon  intestinal  irritation,  DR.  A.  JACOBI 
gives  a  purgative  dose  of  calomel,  following  this  in  a 
few  hours  afterward  by : 

Jfr.    Chloral,  hydrat.  gr.  iv. 

Potass,  bromidi         .         .  gr.  viii. 

Aquae       ..... 
Syrupi aa  q.s. 

M.    Sig.  Dose,  to  a  child  of  two  years. 

This,  he  finds,  together  with  attention  to  diet  and 
proper  hygiene,  is  usually  sufficient.  During  the 
convulsive  spasms  he  also  cautions  that  the  child 


CONVULSIONS.  147 

must  not  be  touched,  since  such  disturbance  may 
increase  their  severity,  or  give  rise  to  others  when 
the  patient  is  recovering. 

In  the  nervous  disturbances  and  excitements  of 
children,  DR.  A.  A.  SMITH  uses  the  bromides  very 
beneficially.  He  advises,  however,  that  the  adminis- 
tration of  bromide  to  young  children  is  often  difficult, 
on  account  of  the  disagreeable  taste  attending  its 
use.  This  he  very  effectually  obviates  by  giving  the 
drug  in  small  and  frequently  repeated  doses  ;  usually 
selecting  the  sodium  salt  for  this  purpose,  as  being 
less  nauseating,  and  administering  it  as  follows  : 

~fy.    Sodii  bromidi       .         .         .     gr.  xxx-lx. 
Aquae §  iv. 

M.  Sig.  A  teaspoonful  every  ten  or  fifteen  min- 
utes. 

When  given  in  this  manner,  he  finds  that  the 
remedy  often  renders  most  valuable  service  in  the 
nervous  affections  arising  from  dentition  and  other 
causes,  and  in  relieving  the  fever  which,  in  children, 
usually  attends  any  slight  degree  of  excitement. 

Also,  in  those  cases  of  highly  nervous,  fretful,  and 
excitable  children,  so  frequently  met  with,  where 
there  is  inability  to  sleep  at  night,  the  indication 
being  to  administer  a  sedative,  he  recommends  the 
following,  which  has  been  used  by  him  with  much 
satisfaction : 


14§  CONVULSIONS. 

$.    Tinct.  chamomillae          .         .         m.  viii. 
Aquae     .         .         .         .         .  §  i. 

M.  Sig.  A  teaspoonful  every  fifteen  or  twenty 
minutes. 

This,  he  advises,  is  also  a  tonic  as  well  as  sedative, 
and  in  these  cases  acts  far  better  than  chloral  hydrate 
which  is  often  liable  to  affect  the  digestion. 

In  the  convulsions  of  childhood,  during  an  attack, 
whether  due  to  organic  disease  or  to  functional 
disturbance,  DR.  SMITH  directs  that  the  convulsion 
be  arrested  at  once  and  another  prevented  by  the 
administration  of  anaesthetics,  preferably  cJdoro- 
fonn.  If  dependent  upon  pain  produced  by  other 
than  causes  such  as  the  pricking  of  a  pin,  tight  abdo- 
minal bandage  which  can  be  easily  removed,  or  an 
overloaded  stomach  which  should  be  emptied  by  an 
emetic,  he  considers  opiiim  the  most  valuable  rem- 
edy, employing  it  in  all  children  over  four  months 
old.  Where  the  convulsion  depends  upon  the  pain 
of  teething,  he  first  controls  this  by  opium,  and  then 
uses  the  gum  lancet.  Regarding  lancing  the  gums, 
he  believes  that  if  they  are  swollen  and  hot,  they 
should  be  lanced ;  or,  if  it  is  time  for  the  tooth  to 
appear,  he  also  resorts  to  scarification,  as  he  finds 
that  the  irritation  is  often  due  to  deepseated 
pressure  which  is  not  manifest  upon  the  sur- 
face. In  such  cases,  according  to  his  experience, 


CONVULSIONS.  149 

lancing  the  gums  is  frequently  followed  by  marked 
relief. 

The  same  principle  is  embodied  in  his  treatment 
of  convulsions  due  to  worms,  or  other  foreign  bodies 
in  the  intestinal  canal.  Opium  is  first  administered 
and  then  a  cathartic  given ;  or  sometimes  he  com- 
bines the  opiate  and  cathartic  with  advantage. 
Where  the  source  of  irritation  is  in  the  rectum,  or 
near  it,  after  the  influence  of  opium  is  sufficiently 
secured  to  control  the  convulsion,  an  enema  is  given. 

In  convulsions  due  to  malarial   poison,  having  ar- 

• 
rested  the  paroxysm  by  opium,  he  puts  the  child 

fully  under  the  influence  of  quinine  to  prevent  its 
recurrence.  In  this  latter  class  of  cases,  he  advises 
that  the  tolerance  of  opium  is  sometimes  very 
great. 

Therefore,  as  in  most  instances,  opium  is  indicated, 
he  directs  the  mother  to  give  the  baby,  if  over  four 
months  old,  paregoric,  with  explicit  instructions  re- 
garding the  size  of  the  dose,  to  be  repeated  every 
half  hour  until  the  convulsion  ceases,  or  a  physician 
arrives.  Where  the  child  is  under  four  months  of 
age,  he  prescribes  the  following  with  best  effect : 

Ijfc.    Potass,  bromidi     .... 
Chloral,  hydrat. 

Sodii  bicarb.  aa  gr.  xvi. 

Aquae  ferv.  .         .         .         .         §  ii. 


1 50  CONVULSIONS. 

Sacchari q.s. 

M.    Sig.  A  teaspoonful  every  hour. 

Many  times,  however,  in  infants  from  six  weeks  to 
four  months  old,  he  gives  double  the  quantity  every 
hour,  or  every  two  hours,  according  to  the  frequency 
and  the  violence  of  the  convulsions. 

Regarding  the  use  of  the  hot  bath,  DR.  SMFTH 
finds  that  one  or  more  spasms  almost  invariably 
occur  while  the  child  is  in  the  bath,  owing  to  the 
excitement,  etc.,  in  administering  it  ;  hence,  as  it  is 
necessary  to  the  treatment  to  avoid  all  agitation,  he 
objects  to  its  employment.  He  moreover  insists 
that  the  child  be  not  restrained  while  in  a  convul- 
sion, but  that  it  be  placed  in  bed  in  a  room  which  is 
kept  perfectly  quiet,  partially  darkened,  and  supplied 
with  plenty  of  fresh  air.  The  opening  and  shutting 
of  doors  are  also  to  be  avoided,  and  only  one  person 
permitted  to  remain  in  the  room  at  a  time.  These 
minute  particulars  he  considers  essentially  of  great 
importance.  He  further  advises  that  all  over-active 
treatment  is  not  only  uncalled  for,  but  may  be  posi- 
tively dangerous. 

In  those  instances  where  the  prolonged  use  of 
opium  is  undesirable,  he  believes  the  bromides  to  be 
of  marked  value ;  their  sedative  effect  must,  how- 
ever, be  maintained.  He  finds  their  action  very 
useful  in  averting  threatened  attacks ;  also  particu- 


CONVULSIONS.  151 

larly  favorable  in  the  cases  of  convulsions  in  young 
children,  apparently  due  to  the  intense  itching  which 
especially  follows  scarlet  fever  and  measles.  Where, 
however,  the  symptoms  are  aggravated  by  the  bro- 
mides, he  uses  chloral  with  good  effect.  In  the  convul- 
sions of  hooping  cough,  he  gives  the  bromides  and 
chloral  in  combination.  If  associated  with  disease 
where  there  is  a  tendency  to  heart  failure,  or  with 
the  exhaustion  of  severe  diarrhoea,  he  resorts  to 
stimulants,  preferably  musk  and  camphor.  In  con- 
vulsions depending  upon  high  temperature,  he 
administers  veratrum  viride,  as  follows: 

1$.    Tinct.  verat.  viridis         .         .  gtt.  ii. 

Sig.     Dose,  every  hour  or  two,  to  a  child  of 
six  to  eighteen  months. 

Or,  he  sometimes  gives  it  in  combination  with 
opium,  thus  preventing  its  tendency  to  cause  vomit- 
ing. Where  this  remedy  fails,  however,  he  orders  a 
cold  bath,  as  the  most  efficient  means  for  this  object. 
For  the  convulsions  occurring  at  the  onset  of  an 
acute  pulmonary  affection,  he  finds  the  administration 
of  calomel  in  sedative  doses  of  gr.  v.,  to  a  child  of  one 
to  three  years,  often  very  serviceable.  This  he  also 
combines  with  the  use  of  veratrum  viride  and  the 
cold  bath,  if  necessary. 

Regarding  the  subsequent  treatment,  DR.  SMITH 
advises  that  the  child  be  kept  in  the  best  possible 

• 


152  CONVULSIONS. 

condition,  at  the  same  time  directing  his  treatment 
to  the  removal  of  the  causes,  as  well  as  of  the  pre- 
disposing causes ;  e.  g.,  the  rickety  diathesis,  syphilis, 
rheumatism,  disturbance  of  digestion,  nervous  excite- 
ment, etc. 

In  the  spasms  occurring  in  young  girls  at  about 
the  age  of  puberty,  and  evidently  due  to  a  diffused 
pelvic  irritation,  no  dyspepsia  or  local  disease  being 
present,  DR.  E.  C.  SEGUIN  finds  medicinal  treatment 
somewhat  uncertain.  He  sometimes  derives  benefit 
from  giving  the  bromide  of  potassium  in  moderate 
doses,  thus : 

Iji.    Potass,  bromidi         .         .               gr.  xx. 
Aquae q.  s. 

M.    Sig.     Dose,  every  night. 

In  addition  to  this  he  applies  a  blister  to  the  back 
of  the  neck,  with  much  benefit.  In  other  cases, 
however,  this  treatment  entirely  fails  of  relief. 
Again,  he  uses  ergot,  giving  it  in  view  of  the  theo- 
retical cause  of  fullness  of  the  ovarian  plexuses,  and 
has  at  times  found  it  very  serviceable. 

For  local  action  in  controlling  infantile  convul- 
sions, the  following  is  very  highly  recommended  by 
some,  and  has  been  found  to  almost  invariably  arrest 
the  paroxysm : 

I£.    Olei  succini  rectif 

Tinct.  opii aa  §  ss. 


CHOREA.  153 

Olei  olivse     ..... 
Spts.  vini  gall.      .        .        .         .  aa  §  ii. 
M.    Ft.  lotio. 

Sig.     Rub  along  the  spine. 

Before  the  application  is  made,  it  is  directed  that 
especial  care  should  be  taken  to  see  that  the  skin  is 
well  washed  with  warm  water  and  soap,  in  order  to 
promote  rapid  absorption. 


CHOREA. 


DR.  J.  LEWIS  SMITH  finds  that  under  good  hy- 
gienic conditions  this  disease  usually  terminates  in  a 
few  months.  This  termination  he  endeavors  to 
hasten  by  suitable  treatment.  If  the  child  attends 
school,  especially  public  school,  the  disease  is  apt  to 
be  aggravated  by  the  severe  discipline  attached  to 
these  institutions,  therefore  he  advises  remaining  at 
home  for  a  season.  For  internal  treatment,  where 
no  organic  lesion  is  present  to  account  for  the  chorea, 
and  considering  the  case  purely  as  a  neurosis,  he 
usually  derives  much  benefit  from  placing  the  child 
on  the  use  of  arsenic,  giving: 

Ijfc.  Liq.  potass,  arsenit.         .         .         .  gtt.  v. 


I$4  CHOREA. 

Aquae q.s. 

M.  Sig.  Dose,  three  times  daily,  to  a  child  of 
eight  to  ten  years. 

This  is  gradually  increased  to  gtt.  viii-x.  three 
times  daily. 

Or,  in  other  cases,  he  gives  Fowler's  solution, 
m.  ii.  after  each  meal,  together  with  the  follow- 
ing: 

9>.    Ferri  et  potass,  tart .         .         .         .     3i- 
Tinct.  cinch,  co.       .         .         .         .   §  iv. 

M.    Dose :   A  teaspoonful  three  times  daily. 

With  these  measures,  he  insists  that  the  hygiene  of 
the  patient  should  be  strictly  attended  to,  the 
bowels  kept  open,  plain  nourishing  food  given,  and 
pure  air  insured.  By  careful  attention  to  these 
means  improvement  rapidly  follows. 

In  cases  of  chorea  associated  with  organic  heart 
disease,  with  anaemia,  etc.,  for  general  treatment, 
where  there  is  little  or  no  fever,  DR.  A.  JACOBI  admin- 
isters a  course  of  iron.  For  this  purpose  he  prefers 
the  subcarbonate  or  the  pyrophosphate,  in  doses 
amounting  to  gr.  xx-xxv.  daily.  The  tincture  of  the 
chloride  and  the  muriated  tincture  are  avoided,  from 
being  vascular  irritants.  For  the  chorea,  he  places 
most  reliance  upon  arsenic,  using  either  the  sodium 
or  potassium  salts,  as  follows : 

Jjfc.    Sol.  Fowlerii         ....  gtt.  iii. 


CHOREA.  155 

Aquae q.  s. 

M.    Sig.     Dose,  three  times  daily,  after  meals. 

This  amount  he  gradually  increases  to  gtt.  vi-viii. 
In  all  cases,  he  believes  it  to  be  of  the  greatest  im- 
portance that  these  children  should  rest  well  at 
night ;  hence  in  severe  forms  of  the  disease,  when 
the  muscular  twitchings  persist  disturbing  and  inter- 
rupting the  sleep,  he  endeavors  to  control  this  con- 
dition by  the  administration  of  chloral  and  the 
bromides,  thus : 

Ijfc.    Chloral,  hydrat.        .         .         .         gr.  xv. 
Potass,  bromidi        .         .        gr.  xv-xxiv. 
Sig.     Dose,  at  bedtime,  to  a  child  of  eight  to 
ten  years. 

If  necessary,  to  accomplish  its  object,  he  increases 
the  chloral  to  gr.  xx-xxv. 

DR.  W.  A.  HAMMOND  finds  the  following  often  of 
excellent  service: 

Ipfc.    Zinci  bromidi         .         .         .         .         3  i. 
Syrupi  simp.          .         .        .         .         §  i. 

M.    Sig.  Ten  drops,  three  times  daily. 

In  using  this,  he  advises  that  the  dose  must  be  in- 
creased as  rapidly  as  the  stomach  can  bear  it ;  then, 
with  the  disappearance  of  the  chronic  symptoms,  it 
is  to  be  gradually  lessened.  He  also  prescribes  the 
following  in  many  instances,  and  considers  it  highly 
efficacious : 


1 56  CHOREA. 

IjL    Strychniae  sulph.  gr.  ii. 

Aquae %L 

M.  Sig.  Five  drops,  three  times  daily,  to  a  child 
of  ten  to  fifteen  years. 

DR.  E.  C.  SEGUIN  recommends  hyoscyamus  with 
much  satisfaction.  Regarding  the  administration, 
he  finds  that  it  can  be  given  in  small  doses,  hypo- 
dermically,  with  ease,  and  distinct  effects  obtained 
from  gr.  1^v.  The  following  formula  is  generally 
used  by  him : 

$.    Hyoscyamiae  (Merck's  crystallized)    gr.  i. 

Glycerinae 

Aquae  destill aa  m.  c. 

Acidi  carbol.  pur.      .         .         .          gtt.  i. 

M.    Filtra. 

Sig.  m.  i.  contains  gr.  2J0. 

Of  this  he  considers  m.  ii.  as  a  moderate  dose,  and 
m.  iv.  a  full  dose.  For  administering  by  the  mouth, 
he  uses  tablets  containing  gr.  5*0  very  conveniently. 
He  has  also  found  the  fluid  extract  of  conium  very 
beneficial ;  giving  it  in  large  doses  for  the  purpose 
of  obtaining  the  paralyzing  effects  of  the  drug. 

As  a  rule,  however,  arsenic  is  most  uniformly  suc- 
cessful. In  cases  of  post  choreic  paralysis  he  places 
great  reliance  on  Fowler 's  solution  in  doses  of  gtt.  v. 
at  first,  and  gradually  increasing.  If  the  chorea  is 
violent,  chloral  is  also  given.  By  this  means,  to- 


CHOREA.  157 

gether  with  extra  feeding,  rest,  and  rubbing,  DR. 
SEQUIN  finds  that  these  cases  of  even  very  grave 
paralysis  will  get  well  within  two  or  three  weeks. 
On  the  other  hand,  he  cautions  that  if  large  doses  of 
arsenic  are  given,  the  patient  may  linger  for  months. 
In  his  experience  the  cold  shower,  chalybeates  and 
cold  water  do  not  act  as  quickly  in  chorea  as  the  thor- 
ough arsenical  treatment. 

In  choreic  children,  DR.  W.  H.  THOMSON  con- 
siders zinc  and  arsenic  most  serviceable ;  of  these  he 
prefers  the  former,  giving  zinci  sulphat.  gr.  i.  three 
times  daily,  and  increasing  till  nausea  is  produced. 
From  this  treatment  he  has  had  marked  improve- 
ment within  a  week.  For  the  abnormal  condition  of 
the  nervous  system,  with  faulty  nutrition,  impaired 
memory,  etc.,  he  prescribes  the  following  with 
benefit : 

];&.     Ferri  lactat .      .... 

Quinise  sulph.   ...  aa  gr.  xx. 

Pulv.  carbon gr.  xl. 

M.    Ft.  pulv.  No.  x. 

Sig.  One,  three  times  daily. 

This  he  directs  to  be  taken  in  cod  liver  oil.  He 
further  advises,  that  even  though  great  improvement 
in  the  chorea  takes  place,  yet  the  general  treatment 
is  to  be  continued  for  several  months. 

DR.  E.  G.  JANEWAY,  as  a  rule,  derives  most  success 


I$8  EPILEPSY. 

from  strychnia.  Where  there  is  also  marked  anaemia 
present,  he  places  the  child  on  the  use  of  iron,  in 
small  doses,  and  continues  it  for  some  time. 

At  the  NEW  YORK  HOSPITAL  the  following  arsen- 
ious  acid  tonic  is  continually  employed,  and  is  con- 
sidered to  be  a  most  efficient  combination : 

$.    Acid,  arseniosi      .         .         .  gr.  \. 

Ferri  et  quin.  cit.          .         .         gr.  Ixxx. 
Tinct.  cinchon.  co.       .        .        .         §  ii. 

M. 


EPILEPSY. 


To  ward  off  the  immediate  attack,  DR.  W.  A. 
HAMMOND  directs  that  when  the  child  feels  an  aura, 
gtt.  iii-iv.  of  amyl  nitrite  be  put  upon  a  handker- 
chief and  inhaled.  This  he  has  often  found  very 
efficacious,  and  has  frequently  succeeded  not  only  in 
aborting  a  paroxysm,  but  in  curing  several  cases  of 
epilepsy  by  this  method  alone,  and  without  the  ad- 
ministration of  any  internal  remedy.  In  many 
instances,  however,  he  finds  that  even  when  aborted 
by  amyl  nitrite,  the  paroxysm  is  very  apt  to  recur. 
In  using  it,  he  advises  that  the  drug  should  be  put 


EPILEPSY.  159 

to  the  mouth  so  that  it  may  be  inhaled  thoroughly, 
and  produce  a  sense  of  fullness  in  the  head,  a  ting- 
ling of  the  surface  of  the  body,  and  redness  of  the 
face.  In  certain  cases,  also,  where  the  bromides 
have  failed,  he  has  derived  much  benefit  from  using 
nitrite  of  amyl  internally,  as  follows : 

9.    Amyli  nitriti       ....       gtt.  i. 
Sacchari q.  s. 

M.  Sig.  Dose,  three  times  daily,  increased  gradu- 
ally to  gtt.  iii-iv. 

He  has  also  obtained  excellent  results  from  nitro- 
glycerine (or  glonoin)  in  this  malady,  and  finds  its 
effects  more  permanent  than  amyl  nitrite,  although 
it  takes  a  longer  time  to  act.  In  the  beginning  of 
an  epileptic  attack,  when  used  for  the  same  purpose 
as  amyl  nitrite,  he  is  able  to  effectually  prevent  the 
spasm  of  the  arterioles  by  this  means.  Moreover, 
he  has  employed  nitro-glycerine  quite  successfully 
for  the  permanent  treatment  of  the  disease.  In  the 
status  epilepticus,  and  in  cases  of  long  standing, 
where  the  bromides  have  signally  failed,  he  often 
finds  this  remedy  very  effective.  Or,  in  some  in- 
stances, he  gives  it  in  conjunction  with  the  bromides. 
Regarding  administration,  the  strength  usually  em- 
ployed by  him  is  a  one  per  cent,  solution,  of  which 
he  prescribes : 

"$.    Nitro-glycerin.          .         .         ,          gtt.  i. 


l6o  EPILEPSY. 

Alcohol gtt.  c. 

M.  Sig.  One  drop  three  times  daily,  on  a  lump  of 
sugar. 

This  amount,  he  advises,  is  borne  very  well  by 
children.  After  a  time  he  gradually  increases  the 
administration  to  gtt.  v.  as  required.  Under  this 
treatment,  he  finds  that  some  cases  improve  remark- 
ably, and  not  infrequently  the  attacks  appear  to  be 
permanently  stopped  by  this  agent.  Or,  he  fre- 
quently administers  this  drug  in  pill  form,  of  which 
he  prefers  Metcalf's  preparation. 

As  a  rule,  however,  and  especially  where  the  bro- 
mides have  not  previously  been  given,  DR.  HAM- 
MOND considers  it  best  to  begin  with  their  adminis- 
tration in  some  form.  Regarding  the  old  remedies, 
such  as  the  salts  of  zinc,  etc.,  though  sometimes 
beneficial,  yet  he  finds  them  more  so  in  conjunction 
with  the  bromides  than  when  used  alone.  On  the 
other  hand,  he  advises  that  the  bromides  will  almost 
invariably  reduce  the  frequency  of  the  paroxysms, 
and  if  the  case  is  not  an  old  one,  they  may  effect  a 
permanent  cure.  For  administration  he  prefers  the 
sodium  salt,  as  it  is  much  more  pleasant  to  the  taste, 
and  if  desired  may  be  taken  with  the  food.  In  his 
experience,  the  following  is  considered  to  be  one  of 
the  best  plans  of  treatment,  and  from  which  he  has 
obtained  uniformly  good  results ;  he  insists,  how- 


EPILEPSY.  l6l 

ever,  that  it  must  be  rigidly  carried  out  in  all  its 
details.  In  prescribing  this  treatment  he  usually 
begins  with  : 

]$.    Sodii  bromidi      .         .         .         .          §  iv. 
Aquae Oi. 

M.  Sig.  A  teaspoonful  (gr.xv.)  three  times  daily, 
to  a  child  of  eight  to  twelve  years. 

He  further  directs  that  each  dose  is  to  taken 
largely  diluted  with  water,  as  by  this  means  the  ef- 
fects of  the  drug  are  greatly  increased.  The  efficacy 
of  the  above  solution,  he  also  advises,  will  be  much 
enhanced  by  the  addition  of  potassium  iodide,  "^ss. 

Regarding  the  results  of  this  method,  he  finds  that, 
as  a  rule,  it  will  take  several  days  for  the  drug  to 
produce  its  effects,  as  it  acts  very  slowly.  He  then 
increases  each  dose  by  one-fourth  every  three  months 
for  a  year,  and  continues  it  at  that  amount  for  another 
year ;  after  which  he  commences  to  reduce  in  the 
same  manner,  so  that  during  the  fourth  year  the  pa- 
tient takes  gr.xv.  of  the  bromide  three  times  daily. 
In  this  respect,  however,  he  cautions  that  if  the  quan- 
tity is  not  increased  during  the  first  year,  the  attacks 
will  probably  recur,  thus  adding  to  the  difficulty  of 
arresting  them.  Formerly,  DR.  HAMMOND  used  to 
consider  that  two,  or  possibly  three,  years  was  long 
enough  to  continue  giving  the  bromides  ;  but  of  late 
he  believes  that  a  relapse  is  thus  encouraged,  hence 
ii 


1 62  EPILEPSY. 

he  advises  that  it  is  safer  to  continue  the  treatment 
for  four  years.  If,  however,  after  a  time,  the  bromides 
do  not  produce  so  good  results  as  are  desired,  he 
stops  their  administration  for  a  month  or  longer,  un- 
til the  system  has  become  entirely  free  from  the 
drug,  and  then  begins  the  treatment  anew;  in  the 
meantime  giving  cod  liver  oil  and  tonics,  to  quiet  the 
nervous  irritability,  etc.  Moreover,  in  all  cases,  he 
insists  that  unless  a  certain  degree  of  bromism  is 
produced,  the  disease  cannot  be  cured.  Any  weak- 
ness short  of  inability  to  stand  up,  and  an  acne  erup- 
tion on  the  face  and  chest,  are,  in  his  opinion,  not 
centra-indications  to  a  continuance  of  the  treat- 
ment. 

To  prevent  the  eruption  of  acne,  he  sometimes 
combines  Fowler  s  solution  with  the  bromide  ;  but, 
as  a  rule,  when  injurious  effects  are  produced,  he 
finds  that  the  best  plan  is  to  diminish  the  dose.  The 
combination  of  iron  with  bromide  in  epilepsy,  he 
believes  to  be  harmful.  As  to  quinine,  in  his  expe- 
rience the  use  of  this  drug  in  combination  lessens 
the  effect  of  the  bromides  upon  the  patient. 

In  certain  cases  he  finds  that  indolent  ulcers  are 
caused  by  the  long  use  of  the  bromides ;  these  he 
usually  easily  cures  by  galvanism.  Or,  in  a  great 
many  instances,  pure  bromine  is  employed  by  him 
instead  of  the  salts,  by  which  means  the  acne  and  the 


EPILEPSY.  163 

ulcerative  manifestations  of  the  bromide  are,  he  be- 
lieves, avoided.  His  formula  for  this  administration 
is: 

IjL    Brominii 3i. 

Aquae %vm. 

M.     Sig.  A  teaspoonful,  well  diluted  with  water. 

Another  useful  measure  which  DR.  HAMMOND  re- 
sorts to  very  satisfactorily,  in  the  treatment  of 
epilepsy,  is  counter-irritation,  applied  to  the  back  of 
the  neck  by  means  of  a  platinum  disc,  or  other  in- 
strument, heated  to  a  white  heat.  In  doing  this,  he 
advises  that  it  is  necessary  only  just  to  touch  the 
skin,  and  then  remove  the  cautery  immediately ; 
the  pain  thus  produced  is  so  slight  that  the  patient 
scarcely  feels  it.  By  this  procedure,  he  has  found 
the  number  of  paroxysms  to  be  reduced  after  a 
single  application. 

DR.  J.  LEWIS  SMITH  urges  the  great  importance 
of  making  a  correct  diagnosis  early.  If  this  is  done, 
he  usually  controls  its  manifestations  by  the  free  use 
of  the  bromides,  giving  the  following  : 

]£.    Potass,  bromid.  .         .         .         §ss- 

Aquae  pur.         .  ...  §  v. 

M.  Sig.  A  teaspoonful  three  times  daily,  in  cold 
water. 

This  amount  is  gradually  increased  as  indicated. 

DR.  E.  C.  SEGUIN   believes   that   attacks  of   the 


164  EPILEPSY. 

petit  mal,  or  epileptic  vertigo,  though  seemingly  an 
insignificant  symptom,  is  nevertheless  far  more  se- 
rious than  the  grand  mal,  or  fits,  and  does  not  al- 
ways receive  the  attention  which  its  existence  de- 
mands. He  therefore  considers  that  the  importance 
of  its  early  recognition  cannot  be  magnified,  and  its 
existence  should  be  met  with  prompt  and  careful 
treatment,  at  the  earliest  possible  moment.  The 
bromides  are  prescribed  by  him,  together  with  atten. 
tion  to  the  digestive  apparatus,  etc. ;  although  he 
finds  that  these  cases,  and  especially  the  flash-like 
form, .are  exceedingly  rebellious  to  treatment,  and 
many  children  will  continue  to  have  several  turns  a 
day,  despite  the  administration  of  as  much  bromide 
as  their  systems  will  bear.  In  several  instances  he 
has  found  it  necessary  to  produce  severe  bromism,  in 
order  to  barely  control  these  minor  forms  of  epilepsy  ; 
and  the  least  reduction  of  the  medicine  to  a  safer 
dose,  has  been  followed  by  a  return  of  the  symptoms. 
In  all  forms  of  the  disease,  however,  both  in  grand 
and  in  petit  mal,  he  resorts  to  early  treatment,  if 
possible  after  the  first  or  second  attack,  as  by  this 
means  he  is  often  able  to  eliminate  the  epileptic 
habit,  and  thus  greatly  increase  the  chances  of  cure. 

Regarding  the  convulsions,  in  children  under  three 
years  of  age,  he  advises, the  first  convulsions  may  prob- 
ably be  eclamptic,  but  the  causes  of  the  attack  should 


EPILEPSY.  165 

receive  the  most  careful  judgment.  In  these  cases,  that 
is  to  say,  which  do  not  present  an  evident  eclamptic 
condition,  he  finds  it  well  to  give  a  moderate  amount 
of  potassium  bromide  with  regularity,  for  several 
months  after  a  convulsion.  After  the  third  year  he 
believes  the  attacks  to  be,  as  a  rule,  epileptic,  not 
forgetting  the  possibility  of  uraemia  and  syphilis.  In 
such  children,  he  at  once  institutes  the  bromide 
treatment,  and  continues  it  for  many  months.  This 
plan,  he  advises,  does  not  interfere  with  the  treat- 
ment by  appropriate  remedies  and  by  hygiene,  of 
gastric  or  intestinal  indigestion,  of  worms,  or  of  other 
abnormal  conditions.  Moreover,  in  his  experience, 
even  the  most  severe  fits  can  nearly  always  be  con- 
trolled by  a  proper  dosing  of  the  bromides,  and  may 
also  be  suspended  for  a  period  of  months  and 
years. 

In  giving  the  bromides,  DR.  SEGUIN  always  en- 
deavors to  ascertain  the  minimum  dose  which  will 
control  the  seizure  ;  this  amount  is  then  increased  as 
demanded.  For  administration,  to  commence  with 
he  generally  prescribes : 

$.    Potassii  bromidi  .         .         .          §i. 

Aquae  .         .         .         .         .      §vii. 

M.     Sig.  3  iii-vi.  daily. 

He  also  directs  that  each  dose  be  diluted  with 
vichy  water,  as  in  this  way  the  taste  is  somewhat  dis- 


1 66  EPILEPSY. 

guised ;  or,  when  this  cannot  be  obtained,  he  finds 
that  a  pinch  of  soda  in  the  water  answers  very  well. 
Where  there  is  much  depression  from  the  use  of  the 
bromides,  he  gives  strychnia  with  considerable  effi- 
cacy. In  some  cases  he  has  also  found  iron  to  act 
very  beneficially.  When  indicated,  he  combines 
chloral  with  the  bromide,  and  often  with  remarkable 
effect;  thus: 

Ijfc.     Potassii  bromidi         .         .         .  §  i. 

Chloral,  hydrat.          .         .         .           ^ ss- 
Aquae         .....         ^ v"- 

M.    Sig.  3  iv-vi.  daily,  in  water. 

Again,  in  numerous  instances  he  prefers  to  give 
the  following : 

P.     Ammon.  bromidi       .         .         .  §  ss. 

Potassii  bromidi         ...  §  i. 

Aquae         .....          §vii. 

M.  Sig.  3  iii-iv.  daily,  increasing  the  amount  as 
required. 

Furthermore,  besides  the  use  of  the  bromides,  he 
finds  that  a  variety  of  treatment  is  frequently  re- 
quired, according  to  the  pathological  condition  of 
each  individual  case. 


INFANTILE   PARALYSIS.  167 


INFANTILE  PARALYSIS. 


In  -those  cases  of  paralysis  which  come  on  without 
any  apparent  premonitory  symptoms,  DR.  A.  JACOBI 
relies  a  great  deal  upon  the  galvanic  and  faradic 
current,  and  upon  strychnia  both  subcutaneously  and 
internally,  preferably  the  former,  from  which,  also, 
he  obtains  better  results  by  applying  the  injections 
directly  over  the  affected  part.  For  the  same  reason, 
in  paralysis  of  the  sphincter  ani  due  to  muscular  re- 
laxation, he  uses  the  alcoholic  extract  of  nux  vomica, 
as  an  ointment,  with  the  most  beneficial  effect.  Of 
this,  the  following  strength  is  usually  employed  by 
him: 

Tfc.    Ext.  nucis  vomicae         .         .          gr.  xii. 
Unguent 3  iii-iv. 

M. 

In  so-called  dental,  or  spinal,  paralysis,  to  subdue 
the  local  inflammation,  he  advises  the  application  of 
ice  to  the  surface  for  hours  or  even  days ;  not  for- 
getting, however,  that  infants  and  young  children 
bear  the  protracted  application  of  cold  badly.  For 
this  reason,  he  usually  keeps  the  ice  in  contact  with 
the  surface  for  an  hour  or  two,  and  then,  after  re 
moving  it  for  the  same  period  of  time,  repeats  the 


1 68  INFANTILE   PARALYSIS. 

application ;  continuing  in  this  manner  as  long  as 
necessary.  If  constipation  is  present  he  relieves  it 
by  giving  calomel  in  doses  of  gr.  v-x.  according  to 
age  ;  or  sometimes  a  saline  is  used.  In  these  cases 
he  always  uses  ergot  in  large  doses ;  as  a  rule, 
giving : 

$.     Ext.  ergot,  fl.  ...          3  i. 

Sig.  This  amount  in  twenty-four  hours,  to  a 
child  of  one  year. 

This  administration  he  continues  for  three  or  even 
six  weeks.  Or,  at  times,  larger  doses  are  prescribed 
by  him  ;  in  some  instances  as  much  as  3  ii-  In  other 
instances,  he  prefers  to  use  crgotin  by  Jiypodcrmic  in- 
jection. Where  the  heart  is  feeble  and  requires 
stimulating,  digitalis  is  employed.  After  the  fever 
and  pain  and  all  active  symptoms  have  disappeared, 
he  supplements  the  ergot  by  the  addition  of  iodide 
of  potassium  to  the  amount  of  3  i.  in  twenty-four 
hours.  As  regards  inunction,  he  considers  the  oint- 
ment of  potassium  iodide  of  little  or  no  service.  In 
his  experience  glycerine  and  potassium  iodide  act 
better,  and  he  has  often  observed,  after  such  an  ap- 
plication, the  urine  impregnated  with  iodine  within 
twenty-four  hours.  He  has  also  found  iodoform 
ointment  exceedingly  beneficial,  or  better,  the  fol- 
lowing : 

$.     lodoformi  .         .         .         pars  i. 


INFANTILE   PARALYSIS.  169 

Collodion         .         .         .       part,  xii-xx. 

M.     Sig.   To  be  applied  three  or  four  times  daily. 

Besides,  this  being  non-irritating,  he  finds  that  it 
can  be  continued  for  weeks  with  no  ill  effects. 

Regarding  pseudo-hypertrophic  paralysis,  DR. 
JACOBI  has  succeeded  in  curing  a  case  by  means  of 
the  hydrarg.  corros.  chlor.  in  doses  amounting  to  gr. 
to~6lo  m  twenty-four  hours,  and  continued  for  a 
period  of  eighteen  months.  Under  this  treatment, 
nutrition  was  not  impaired  in  the  least  from  the  ef- 
fects of  the  drug,  but  on  the  contrary  the  child  ate 
and  slept  well,  became  rosy  and  healthful,  and 
the  atrophy  and  hypertrophy  finally  both  gave 
way. 

DR.  F.  DELAFIELD'S  indications  for  treatment  are 
to  support  the  strength  and  nutrition,  and  render 
the  patient  as  comfortable  as  possible.  Any  derange- 
ment of  digestion  is  carefully  attended  to,  and  the 
bowels  kept  freely  open.  While  the  disease  is  pro- 
gressing, he  considers  it  a  good  plan  to  apply  dry 
cups  along  the  spine  ;  but  after  this  stage  has  passed, 
and  the  disease  has  reached  a  systematic  develop- 
ment, he  obtains  marked  benefit  from  using  the 
faradic  current,  and  in  thoroughly  rubbing  the 
muscles  at  stated  periods. 

DR.  W.  A.  HAMMOND  considers  ergot  to  be  of  ex- 
cellent service,  in  cases  of  infantile  spinal  paralysis 


I/O  INFANTILE    PARALYSIS. 

before  the  stage  of  atrophy  has  set  in.    He  generally 
prescribes  : 

#.     Ext.  ergotae  fl.  .         .         .          §  i. 

Sig.  Ten  drops  three  times  daily,  to  a  child 
of  six  months. 

In  conjunction  with  this,  local  measures  are  also 
employed.  After  the  period  of  atrophy  is  reached, 
he  then  administers  the  following : 

$.    Strychnise  sulph.  gr.  i. 

Ferri  pyrophosph.  .  .  .  3  ss. 
Acidi  phosphorici  dil.  .  .  § ss- 
Syrupi  zingiber.  r  .  .  §  iiiss. 

M.  Sig.  m.  xx.  three  times  daily,  to  a  child  of 
two  years. 

From  this  he  has  often  derived   marvelous  effect. 

In  infantile  hemiplegic  paralysis,  DR.  E.  C.  SEGUIN 
varies  his  treatment  according  to  the  pathological 
diagnosis,  e.  g.  The  treatment  of  a  case  depending 
upon  convulsions  from  injury,  will  differ  materially 
from  one  in  which  tubercular  meningitis  is  suspected  ; 
or  one  in  which  some  gastric  irritation  is  thought  to 
exist.  In  the  first  stage  of  hemiplegia  in  children, 
he  finds  that  it  is  best  to  avoid  doing  too  much. 
The  only  exception  to  this,  he  advises,  is  in  cases 
where,  at  an  older  period  than  mere  babyhood,  con- 
vulsions occur  followed  by  hemiplegia  of  a  rather 
slowly  developed  kind,  and  continued  convulsions  in 


INFANTILE    PARALYSIS.  I/I 

which  the  teeth  are  bad,  etc.  In  these  cases  his 
general  rule  not  to  do  too  much  is  reserved.  Mer- 
cury, potassium  iodide,  and  cod  liver  oil  will,  he 
finds,  do  a  wonderful  amount  of  good. 

Regarding  treatment  of  the  sequelae,  nothing  can 
be  done  for  the  pathological  degenerative  changes  in 
the  brain.  Various  clinical  sequelae  are  however 
met  according  to  the  indication.  The  athetoid  and 
choreic  conditions  he  endeavors  to  correct  by  gym- 
nastics, massage,  and  electricity.  Epilepsy,  which  is 
often  present,  is  treated  by  the  bromide  of  potassium  ; 
but  he  advises  that,  in  these  cases,  the  drug  is  not 
required  in  large  doses  as  in  common  epilepsy.  Or, 
in  many  children  who  exhibit  the  remains  of 
hemiplegia  and  epilepsy  at  the  same  time,  DR. 
SEGUIN  has  obtained  excellent  results  from  the  com- 
bination of  the  iodide  and  bromide  of  potassium.  In 
such  cases,  he  generally  gives  : 

Ijfc.    Potass,  iodidi      ....         gr.  v. 
Potass,  bromidi  gr.  x. 

Aquae        .....  q.s. 

M.  Sig.  Dose,  twice  daily,  to  a  child  of  four  or 
five  years. 

At  the  same  time,  he  directs  that  the  general  con- 
dition, the  hygiene,  etc.,  should  receive  the  most 
careful  attention.  Where  imbecility  exists,  this  is 
to  be  corrected  by  judicious  training ;  and  in  the 


1/2  INFANTILE   PARALYSIS. 

case  of  the  poor,  he  advises  that  the  parents  be  in- 
structed to  send  their  children  to  the  schools  for 
idiots.  For  whatever  deformity  that  may  be  present 
he  aims  to  remedy  this  by  proper  treatment,  partly 
by  massage,  by  electrical  treatment,  exercise,  and 
also  by  orthopaedic  apparatus.  In  regard  to  electrical 
treatment,  he  advises  that  this  must  be  applied  to 
the  weakest  muscles.  If  the  whole  arm  is  faradized 
the  child  is  made  worse.  Where,  however,  the 
faradization  is  limited  to  the  extensors  and  interossei, 
he  often  obtains  a  marked  change  in  the  child's  hand 
and  arm  in  the  course  of  a  few  weeks.  Moreover, 
the  current  should  be  strictly  localized  ;  the  elec- 
trodes are  to  be  placed  close  together,  so  as  to  pro- 
duce contraction  in  all  the  weakest  muscles,  the 
flexors  requiring  no  treatment.  Massage  and  passive 
movements  are  also  considered  very  important.  In 
some  cases,  the  maintenance  of  the  normal  attitude, 
or  even  over-extension  in  the  clenched  instances  by 
a  little  apparatus,  will,  he  finds,  do  a  great  deal  of 
good.  The  child  is  also  forced  to  use  the  hands  and 
legs,  at  intervals  ;  the  well  hand  being  tied  up  for  a 
few  hours  a  day,  according  to  the  temperament  of 
the  child.  Finally,  what  in  the  education  of  idiots 
is  called  physiological  training  of  muscles,  is  con- 
sidered of  the  greatest  importance,  and  should  be 
attempted  in  all  cases  ;  e.  g.,  training  the  hand  for 


ACUTE   MENINGITIS.  1/3 

delicate  movements,  by  a  graduated  series  of  little 
muscular  exercises. 

Therefore,  under  this  plan  of  treatment,  carefully 
and  persistently  carried  out,  if  the  circumstances  are 
favorable,  DR.  SEGUIN  finds  that  a  great  deal  can  be 
done  for  these  children. 

AtBELLEVUE  HOSPITAL  the  following  solution  of 
ergot  is  employed  for  hypodermic  use  : 

^.    Ext.  ergotae  e  fl.  (Squibb)         .        gr.  Ix. 
Aquae  q.s.  ad  ...        m.ccc. 

M.    Sig.  m.i.  contains  gr.  i. 

A  similar  preparation  is  also  used  at  the  NEW 
YORK  HOSPITAL. 

At  CHARITY  HOSPITAL  the  following  is  adminis- 
tered : 

$.     Ergotini  gr.  xxxvi. 

Glycerinae 
Aquas          .        .         .  aa  m.  cviii. 

M. 


ACUTE  MENINGITIS. 


To  subdue  the  local  inflammation,  DR.  F.  DELA- 
FIELD  advises  that  the  employment  of  blood-letting 
and  cold  will  depend  upon  the  age  and  constitution  of 


ACUTE   MENINGITIS. 

the  patient,  and  the  period  at  which  the  case  is  seen. 
To  a  strong,  full-blooded  child  in  the  early  stage  of 
the  disease,  he  administers  a  brisk  purge,  and  then 
proceeds  to  draw  blood  by  ivct  cups  or  leeches, 
applied  over  the  temples  and  back  of  the  neck.  This 
procedure,  he  advises,  must  be  resorted  to  at  the 
commencement  and  during  the  first  forty-eight  hours 
of  the  disease,  when  he  finds  it  of  excellent  service ; 
after  that  period  has  passed,  however,  no  benefit  is 
derived  from  its  use.  He  also  employs  cold  in  the 
shape  of  ice-bags,  applied  by  cutting  the  hair  and 
covering  as  much  of  the  surface  of  the  cranium  as 
possible  ;  and  by  placing  an  ice-bag  beneath  the 
neck  and  adjacent  part  of  the  head.  This  applica- 
tion of  cold  he  finds  most  serviceable  during  the 
first  two  or  three  days,  but  continues  its  use  with 
much  benefit  throughout  the  first  week.  Opium  is 
also  administered  in  some  form,  to  quiet  the  restless- 
ness and  delirium. 

If  the  case  is  not  seen  until  five  or  six  days  have 
elapsed,  he  considers  opium,  cold,  bleeding,  and  all 
depleting  measures  contraindicated,  and  should  be 
avoided.  At  this  stage,  he  administers  iodide  of 
potassium  in  moderate  doses,  and  supports  the 
strength  of  the  patient  with  quinine,  iron,  etc. 

When  the  disease  occurs  as  a  complication,  or  in 
asthenic  children,  he  objects  to  blood-letting,  but 


ACUTE   MENINGITIS.  175 

applies  cold  to  the  head  and  administers  opium  to 
relieve  the  pain  ;  or,  should  opium  be  contraindicated, 
he  gives  potassium  bromide  or  chloral,  or  both.  A 
purge  is  also  given  unless  the  bowels  are  already 
relaxed  from  the  concomitant  disease. 

In  cases  of  basilar  meningitis,  DR.  E.  C.  SEGUIN 
derives  excellent  results  from  iodide  of  potassium, 
its  administration  often  causing  amelioration  of  the 
symptoms,  with  rapid  general  improvement  and,  in 
many  instances,  final  recovery.  Moreover,  in  these 
cases  he  believes  syphilis  may  often  be  entirely  ex- 
cluded. In  conjunction  with  this,  he  also  resorts  to 
counter-irritation  by  means  of  blisters,  applied  to  the 
back  of  the  neck.  Regarding  the  use  of  potassium 
iodide,  to  accomplish  its  object,  he  finds  that  large 
doses  may  be  required  and  can  be  given  with  appar- 
ent impunity.  Even  in  young  children  of  eight  to 
ten  years,  he  has,  in  some  cases,  found  it  necessary  to 
give  the  following : 

~fy.    Potassii  iodidi  .         .         gr.  xxx-cl. 

Aquae        .'....  q.s. 

M.    Sig.  Dose,  three  times  daily. 

DR.  W.  A.  HAMMOND  has  also  obtained  like  bene- 
fit from  this  remedy.  In  many  instances,  however, 
he  advises  that  enormous  doses  may  be  necessary 
before  success  follows.  Therefore,  to  facilitate  this 
administration,  when  prescribing  the  drug  he  directs 


ACUTE   IIYDROCEPHALUS. 


that  a  great  deal  of  water  be  taken  with  each  dose, 
sometimes  a  pint,  as  in  this  way  he  finds  that  these 
large  doses  may  be  given  without  any  inconvenience 
and  iodism  prevented. 


ACUTE  HYDROCEPHALUS. 
•  (TUBERCULAR  MENINGITIS.) 


DR.  F.  DELAFIELD  directs  his  treatment  chiefly  to 
the  symptoms.  If  the  urine  is  scanty  or  suppressed, 
he  orders  a  hot  bath  for  the  space  of  five  minutes, 
after  which  the  child  is  immediately  wrapped  in  a 
blanket,  without  waiting  to  dry  the  body,  and  thus 
kept  in  a  sweat  for  one,  two,  or  more  hours. 
Diuretics  he  finds  of  little  use,  although  he  sometimes 
gives  the  iodide  or  acetate  of  potassium.  For  the 
irritability  and  restlessness,  he  administers  the 
bromides  with  chloral  ;  thus : 

~fy.  Potassii  bromidi  gr.  i-v. 
Chloral,  hydrat.  .  .  gr.  i-iii. 
Aquae q.  s. 

M.    Sig.     Dose,  every  two  or  three  hours. 

In  addition  to  this,  to  act  on  the  inflammation,  he 


SPURIOUS   HYDROCEPHALUS.  I// 

uses  potassium  iodide  in  doses  of  gr.  ii-v.  according  to 
the  severity  of  the  case.  Locally,  counter-irritation 
is  resorted  to  by  means  of  blisters  applied  to  the 
neck.  He  also  applies  cold  to  the  scalp,  ab- 
stracts blood  from  the  temples,  and  produces  free 
catharsis.  For  internal  medication  DR.  DELAFIELD 
further  administers  ext.  ergotce  fl.  in  large  doses. 
Where  convulsions  are  very  marked,  chloroform  may 
be  resorted  to  chiefly  for  the  mother's  sake. 

In  the  earlier  stages,  before  effusion  has  taken 
place,  the  two  remedies  upon  which  DR.  J.  LEWIS 
SMITH  places  most  reliance  are  ergot  and  potassium 
iodide.  If  nervous  symptoms  are  developed  he 
gives  bromide  of  potassium  in  addition.  He  usually 
prescribes : 

$.     Potassii  iodidi         .         .         .         gr.  xvi. 
Aquae      .         .         .         .         .         .       §  i. 

M.  Sig.  A  teaspoonful  every  hour,  to  a  child  of 
one  year. 

With  this  he  gives  fluid  extract  of  ergot  (Squibb 's) 
gtt.  vi-viii.  every  three  hours.  As  regards  post  aural 
vesication,  although  it  does  no  harm,  yet  he  believes 
that  very  little  good  results  from  resorting  to  it. 


SPURIOUS   HYDROCEPHALUS. 

See  CHOLERA  INFANTUM. 


1/8  CHRONIC   IIYDROCEPHALUS. 


CHRONIC    HYDROCEPHALUS. 


In  congenital  cases,  DR.  F.  DELAFIELD  finds  that 
very  little  can  be  done  in  the  way  of  treatment, 
beyond  supporting  the  nutrition  of  the  child  by 
suitable  means,  and  correcting  the  disordered  diges- 
tion. By  careful  attention  to  these  measures,  in  the 
milder  forms  of  the  disease,  the  child  may  improve. 

In  cases  of  acquired  hydrocephalus,  that  is  to  say, 
where  the  lesion  occurs  secondarily,  he  finds  that 
treatment  is  altogether  useless. 

Regarding  tapping,  DR.  E.  C.  SEGUIN  does  not 
apprehend  any  special  danger  from  the  operation  ; 
this,  he  believes,  will  lie  more  in  the  hemorrhage 
than  in  the  reaction,  in  these  cases.  He  advises, 
however,  that  if  the  hydrocephalus  is  due,  as  is  some- 
times the  case,  to  a  plugging  of  the  aqueduct  of 
Sylvius,  tapping  can  only  act  as  a  mechanical  relief. 
Also,  if  the  disease  affects  the  ventricular  lining,  he 
would  hardly  expect  more  than  momentary  relief 
from  tapping. 


CEREBRO-SPINAL   MENINGITIS.  179 


CEREBRO-SPINAL    MENINGITIS 

The  treatment  adopted  by  DR.  F.  DELAFIELD  is 
very  largely  symptomatic.  For  the  local  lesion,  he 
advises  that  bleeding  should  rarely  be  practiced  in 
children,  although  in  robust  patients  he  sometimes 
abstracts  blood  from  the  temples,  the  neck,  or  along 
the  upper  part  of  the  spine.  This  measure,  he  fur- 
ther cautions,  is  of  service  only  during  the  first  three 
or  four  days,  and  if  the  case  is  not  seen  until  then, 
bleeding  is  contraindicated.  He  also  applies  cold  to 
the  head  and  back  of  the  neck,  by  means  of  ice-bags, 
and  in  severe  cases  this  is  kept  up  continually  for 
the  first  week.  These  measures  are,  he  finds,  the 
most  efficient  means  of  treatment,  but  insists  that 
they  are  available  only  during  the  first  stage  of  the 
disease. 

For  the  restlessness  and  delirium,  when  excessive, 
he  administers  the  bromides,  or  chloral,  or  hyoscy- 
amus.  He  frequently  gives  potassium  bromide  gr. 
iii-x.  every  three  hours,  but  considers  it  more  efficient 
when  combined  with  one  of  the  other  drugs.  Also, 
where  the  child  cannot  take  the  bromide  alone,  he 
usually  prescribes  the  following  : 

^L    Potassii  bromidi         .         .         .    gr.  iii-x. 


180  CEREBRO-SPINAL   MENINGITIS. 

Tinct.  hyoscyami       .         .         .  m.xv-xl. 

M.    Sig.     Dose,  every  three  hours. 

At  times,  he  finds  it  necessary  to  resort  to  opium. 
Regarding  quinine,  he  advises  that  it  should  be  em- 
ployed only  as  a  matter  of  routine,  as  he  believes 
that  it  has  very  little  effect  on  the  temperature. 
Where  the  fever  runs  high  he  prefers  cold  as  an  anti- 
pyretic ;  either  in  the  form  of  affusions,  or  the  cold 
or  tepid  bath,  or  occasional  sponging  which  serves  to 
render  the  patient  more  comfortable.  Stimulants 
are  also  used  by  him  in  the  later  stages  of  bad  cases, 
but,  as  a  rule,  he  finds  no  indication  for  them  during 
the  course  of  the  disease.  For  the  vomiting,  when 
it  occurs  in  the  early  stage  he  disregards  it  alto- 
gether, unless  very  excessive,  or  continued  beyond 
twenty-four  or  forty-eight  hours ;  in  such  cases,  he 
directs  that  small  and  frequent  allowances  of  iced 
milk  and  lime  water  be  administered,  and  the  patient 
given  small  pieces  of  cracked  ice  to  swallow.  Should 
the  vomiting  still  persist,  he  finds  the  following  used 
with  caution,  very  successful  in  checking  it : 

Ijfc.    Acid,  hydrocyan.dil.  .         .  m.  i-ii. 

Sodii  bicarbon.  .         .         .  gr.  iii-v. 

M.  Sig.  Dose,  every  three  or  four  hours,  to  a 
child  of  eight  to  twelve  years. 

The  constipation  he  relieves  by  an  occasional  mild 
laxative. 


CEREBRO-SPINAL   MENINGITIS.  l8l 

For  the  conjunctivitis,  DR.  DELAFIELD  resorts  to 
the  continued  application  of  hot  or  cold  cloths,  ac- 
cording as  one  or  the  other  affords  most  relief  to  the 
patient,  but,  in  either  case,  he  insists  that  they  be 
made  hot  or  cold,  not  warm.  When  keratitis  is 
present  he  uses  hot  cloths,  together  with  the  follow- 
ing: 

IpL    Atropiae  sulphat.         .         .         .  gr.  ii-iii. 
Aquae  destil §  i. 

M.  Sig.  To  be  dropped  into  the  eye,  three  times 
daily. 

The  inflammation  of  the  choroid,  he  advises, 
cannot  be  effectively  treated  ;  all  that  can  be  done 
is  to  relieve  the  pain  by  a  sufficient  amount  of 
opium. 

For  the  general  nutrition  of  the  patient,  this  he 
maintains  by  a  diet  of  milk,  or  milk  and  beef-tea, 
frequently  administered. 

DR.  J.  LEWIS  SMITH  places  the  child  freely  under 
the  influence  of  potassium  bromide,  with  ergot  in  the 
beginning,  and  the  local  use  of  cold  in  the  shape  of 
ice-bags,  applied  to  the  head  and  neck.  He  also 
resorts  to  the  moderate  and  cautious  employment  of 
opiates,  for  the  relief  of  pain  and  to  procure  rest. 
During  the  first  two  or  three  weeks  he  considers 
medicinal  treatment  of  most  importance.  After  this 
period  has  passed,  however,  his  chief  reliance  is  upon 


1 82  CEREBRO-SPIXAL   MENINGITIS. 

good  nursing,  and  the  use  of  a  nutritious  but   non- 
stimulating  diet. 

In  sudden  attacks  of  severe  cases,  where  the  gen- 
eral symptoms  are  marked,  opisthotonus  prominent, 
and  with  jactitation,  convulsions,  etc.,  DR.  F.  A. 
BURRALL  directs  that  a  mustard  bath  be  given  and 
sinapisms  applied  to  the  neck,  together  with  sol. 
morph.  sulph.  (Magendie)  m.  iii-iv.  hypodermically, 
to  a  child  of  eight  or  ten  years.  This  usually 
shortens  the  duration  of  the  paroxysms  and  dimin- 
ishes their  intensity.  Should,  however,  this  condi- 
tion persist  or  exaggerate  in  degree,  with  increasing 
stupor,  he  administers  the  hot  mustard  bath  three 
times  daily,  and  applies  continuous  strong  sinapisms 
to  the  nape  of  the  neck,  with  the  effect  usually  of 
rendering  the  patient  more  quiet.  These,  together 
with  the  bath,  are  also  continued  as  required.  For 
the  constipation,  hydrarg.  chlor.  mit.  gr.  \  is  given 
every  hour,  until  free  fecal  movement  is  established. 

He  also  gives  the  following  internally,  and  gener- 
ally with  beneficial  effect : 

IJ.    Potassii  iodidi  gr.  v. 

Potassii  bromidi  gr.  x. 

Aquae q.  s. 

M.    Sig.  Dose,  every  two  hours. 

In  some  instances,  however,  he  has  used  up  to 
3  i.  of  the  bromide,  with  little  or  no  relief  whatever. 


CEREBRO-SPINAL   MENINGITIS.  183 

To  control  the  restlessness  at  night  and  secure 
sleep,  he  gives  tinct.  opii  deodar.  3  ss.  in  divided 
doses.  This,  together  with  the  bromide,  is  also  freely 
administered  during  the  day,  when  demanded. 

For  nourishment,  a  diet  of  milk  is  ordered,  com- 
bined with  stimulants,  usually  brandy,  in  the  propor- 
tion of  ^  ss.  to  5  iy-  °f  milk  ;  this  is  given  ad  lib.  and 
the  brandy  increased  as  required. 

DR.  W.  H.  DRAPER  advises  that  the  child  be  con- 
fined to  bed,  and  kept  perfectly  quiet  and  at  rest. 
As  rest  is  considered  to  be  thoroughly  essential  to 
the  treatment,  where  there  is  much  agitation  ex- 
hibited he  keeps  the  patient  under  the  influence  of 
opium,  in  sufficient  quantity  for  this  purpose.  The 
rational  measures  employed  by  him  consist  in  the 
internal  administration  of  ergot  and  iodide  of  potas- 
sium. The  ergot  is  given  in  large  doses,  in  order  to 
control  the  amount  of  blood  carried  to  the  spine ; 
and,  as  a  rule,  he  finds  that  the  drug  acts  favorably 
in  this  disease,  although  in  some  instances  ergot 
affords  absolutely  no  benefit  at  all.  Where  the  patient 
is  unable  to  retain  medicine  by  the  mouth,  he  uses 
the  hypodermic  method.  In  conjunction  with  this 
potassium  iodide  is  also  administered,  either  by  the 
stomach  or  rectum,  with  the  object  not  only  of  con- 
trolling the  inflammation,  but  also  of  removing  the 
inflammatory  products.  In  addition,  the  patient  is 


184  SPINA   BIFIDA. 

usually  allowed  to  take  all  the  food  wanted,  causing 
no  serious  consequence. 

These  means  of  treatment  are,  in  his  experience, 
not  always  reliable,  and  in  some  instances  are  en- 
tirely negative,  e.  g.  In  certain  cases  he  finds  salicylic 
acid  in  doses  of  gr.  viii-x.  every  two  hours,  very  ser- 
viceable, on  the  plan  of  its  utility  in  infectious 
diseases. 


SPINA  BIFIDA. 


In  young  children  where  the  general  health  is  ap- 
parently good,  while  the  tumor  is  present  and  small 
in  circumference,  DR.  L.  A.  SAYRE  believes  that,  as 
a  rule,  it  is  best  to  wait  for  nature  to  form  a  bony 
covering  over  the  exposed  parts,  just  as  the  fonta- 
nelles  are  closed  in.  In  the  meantime,  should  the 
tumor  have  reached  any  considerable  proportions, 
he  protects  it  artificially,  and  endeavors  to  assist  os- 
sification by  the  administration  of  internal  remedies. 
The  former  he  accomplishes  by  means  of  a  plaster 
jacket  carefully  applied,  and  perfectly  encasing  the 
tumor ;  thus,  also,  guarding  against  any  injury  to  the 
part.  Or,  a  piece  of  steel  or  copper  plate  of  appro- 


SPINA   BIFIDA.  185 

priate  shape,  he  finds,  sometimes  answers  equally  as 
well,  provided  it  can  be  kept  in  exact  position ;  on 
account  of  this  usual  difficulty,  however,  he  greatly 
prefers  the  plaster  dressing.  For  internal  treatment, 
he  places  the  child  on  a  course  of  lime,  using  the 
phosphate  with  a  view  of  increasing  the  earthy  phos- 
phates in  the  system,  and  thus  facilitating  the 
further  ossification  of  the  spinal  column. 

After  repeating  the  plaster  application  as  occasion 
requires,  DR.  SAYRE  sometimes  resorts  to  aspiration 
with  much  satisfaction,  and  in  many  instances  no  in- 
convenience whatever  is  experienced  during  the  op- 
eration, or  subsequently,  beyond  some  nausea  and 
vertigo  on  rising  in  the  morning.  Where  the  tumor 
refills  rapidly,  he  often  finds  it  necessary  to  .put  in  a 
permanent  drain. 

In  infantile  cases,  DR.  A.  JACOBI  sometimes  places 
the  child  on  the  systematic  administration  of  ergot 
and  iodide  of  potassium,  given  in  small  doses,  and 
continued  for  a  considerable  period  of  time. 

DR.  H.  B.  SANDS  advises  that  although  such 
measures  are  not  entirely  hopeless,  yet  operations 
for  removal  of  the  tumor  are,  as  a  rule,  attended  by 
disastrous  results.  When  he  resorts  to  any  form  of 
treatment,  it  is  more  frequently  by  the  injection  of 
iodine,  or  some  such  fluid. 

[LISTER  considers  the  following  plan  of  treatment 


1 86  TYPflOID    FEVER. 

the  best  at  present  known,  and  believes  that  incision 
or  antiseptic  drainage,  even  with  only  one  or  two 
horsehairs,  do  not  offer  a  prospect  of  success.  Where 
the  tumor  is  steadily  increasing  in  size,  he  draws  off 
about  an  ounce  of  the  fluid,  and  injects  3  i-  of  Morton  s 
iodo-glycerine  solution.  If  no  effect  is  produced,  in 
about  a  week's  time  he  repeats  the  operation,  inject- 
ing 3  iss.  of  the  solution.  As  a  rule,  no  bad  symp- 
toms follow,  and,  in  favorable  cases,  under  this 
treatment  he  finds  that  the  tumor  gradually  becomes 
solid,  and  shrinks  until  it  remains  as  a  puckered  fold 
of  skin  only.  Of  late,  however,  in  many  instances 
he  recommends  that  no  fluid  whatever  be  drawn, 
from  danger  of  fatal  consequences  from  loss  of  the 
cerebro-spinal  fluid.] 


TYPHOID  FEVER. 


DR.  W.  H.  DRAPER  directs  his  treatment,  (a)  to 
maintaining  the  strength  of  the  patient,  and  (b)  to 
guarding  against  the  accidents  which  are  liable  to 
occur. 

Rest  is  considered  absolutely  essential.  Any  source 
of  irritation  is  avoided,  and  all  disturbing  thoughts 


TYPHOID   FEVER.  187 

and  muscular  movements  carefully  prevented.  This, 
he  advises,  should  always  be  insisted  upon,  as  pa- 
tients often  exhaust  themselves  greatly  during  the 
early  stage  of  the  disease,  by  being  up  and  about  as 
usual,  and  thereby  lessen  their  chances  for  a  good 
recovery. 

For  the  diet,  these  patients,  he  directs,  should  not 
be  over-fed.  It  should  also  be  remembered,  in  feed- 
ing, for  what  object  the  food  is  given.  When  con- 
fined to  bed,  very  little  mental  or  mechanical  work 
is  done  ;  hence,  the  most  important  use  for  food  is 
to  repair  the  loss  of  heat  resulting  from  fever. 

If  there  is  high  fever  with  active  delirium,  more 
food  is  required  than  in  low  fever.  Milk  is  believed 
by  him  to  be  the  best  kind  of  food  for  the  great  ma- 
jority of  cases.  Sometimes,  however,  the  patient 
cannot  take  a  purely  milk  diet  for  any  length  of 
time  ;  in  such  instances,  concentrated  broths  are 
given.  These  measures,  judiciously  employed,  are, 
in  many  cases,  all  that  he  finds  necessary. 

In  the  severer  forms  of  the  disease,  to  control  the 
high  temperature  is,  he  advises,  the  most  important 
feature  in  the  treatment,  and  must  be  accomplished 
by  every  possible  means.  If  this  is  not  done,  the 
patient  dies  from  simple  exhaustion.  For  an  anti- 
pyretic, cold  is,  in  his  experience,  perhaps  the  most 
reliable  ,  used  in  the  form  of  the  bath,  pack,  etc. 


1 88  TYPHOID   FEVER. 

These,  he  finds,  have  the  greatest  power,  and  are 
therefore  useful  for  the  greatest  emergencies.  While, 
however,  this  is  employed  with  benefit  in  the  early 
part  of  the  disease,  yet  in  the  later  stages  he  con- 
siders it  dangerous  to  the  visceral  lesions.  The  bath, 
he  directs,  should  be  kept  by  the  side  of  the  bed,  to 
avoid  any  unnecessary  moving  of  the  patient.  Its  use 
is  resorted  to,  and  the  process  repeated  as  often  as 
necessary,  indicated  by  the  fever ;  and  in  this  way 
the  temperature  is  continually  kept  near  the  normal 
standard.  Where  the  bath  is  not  practicable,  he  em- 
ploys frequent  sponging  very  effectually  ;  either  with 
warm  or  cool  water,  or  with  water  and  alcohol.  This 
method  is  also  less  irritating  to  children,  and  is  often 
quite  successful  in  keeping  the  fever  under  control. 
This,  however,  he  further  assists  by  the  administra- 
tion of  diuretics  and  diaphoretics,  allowing  the  pa- 
tient to  drink  freely  of  cold  water,  thereby  cooling 
the  blood,  and  favoring  the  excretion  of  matters 
which  result  from  high  temperature.  Cold  water 
enemata  are  also  administered,  too  much  covering 
avoided,  and  an  abundance  of  cool  and  fresh  air  se- 
cured. This  latter  he  finds  exceedingly  beneficial ; 
indeed,  in  his  experience,  cases  treated  in  the  open 
air  show  a  much  larger  proportion  of  recoveries. 

Regarding  the    action    of   quinine,    DR.    DRAPER 
sometimes  uses  it  in  large  doses,  as  an  anti-pyretic, 


TYPHOID   FEVER.  189 

and  with  good  effect  ;  but  its  results  have  not  proven 
uniformly  successful.  When  of  service,  he  frequently 
finds  that  it  owes  its  power  to  an  effect  on  the  essen- 
tial cause  of  the  fever.  Where,  however,  in  this  dis- 
ease, the  temperature  makes  rapid  and  marked  ex- 
cursions, he  often  gives  quinine  with  great  benefit. 
But  to  attain  this,  he  insists  that  the  drug  must  be 
administered  in  large  doses  ;  small  dosing  does  not 
appear  to  have  the  slightest  control  in  typhoid  fever. 
For  hypodermic  use,  the  following  is  employed : 
IJ.  Quiniae  sulph.  .  .  .  gr.clx. 

Ac.  hydrobrom.  (Squibb)         .  3  i- 

Spts.  frumenti  ad  .  §  i. 

M.     Ft.  sol. 

Alcohol,  he  advises,  acts  as  an  antipyretic  by  fur- 
nishing a  food  which  is  easily  appropriated,  and  thus 
supplies  the  force  which  the  patient  loses  in  heat, 
and  saves  loss  and  exhaustion  from  combustion  of 
the  tissues.  The  amount  required  varies  in  different 
cases ;  it  is  given  until  the  desired  effect  is  obtained. 
In  some  children, 

Vini  xerici  ....  §  ii-iii. 
daily,  is  found  to  be  sufficient ;  in  others,  brandy  in 
larger  amount  is  necessary.  By  its  stimulating  effect 
it  also  quells  the  delirium  and  controls  the  locomotor 
disturbances.  The  heart's  action  becomes  more 
steady  and  firm,  and  the  first  sound,  which  may  have 


190  TYPHOID   FEVER. 

been  feeble  or  absent,  grows  distinct.  In  all  cases, 
however,  he  directs  that  its  administration  should  be 
cautiously  proceeded  with,  and  considers  it  of  the 
greatest  importance  to  bear  in  mind  the  indications 
for  its  use,  viz :  Alcohol  is  demanded  when  the  pa- 
tient exhibits  symptoms  of  marked  nervous  prostra- 
tion, with  subsultus,  delirium  at  night,  jactitation, 
with  a  position  in  bed  indicating  great  physical  de- 
bility, and  with  a  dry  tongue ;  all  coming  on  with 
the  increase  of  temperature.  Under  such  circum- 
stances, as  a  rule,  it  controls  the  delirium  and  the  lo- 
comotor  derangements,  the  patient  sleeps  quietly, 
the  tongue  becomes  moist,  and  the  whole  aspect  of 
the  case  is  changed  for  the  better.  If,  however,  it 
increases  the  frequency  of  the  pulse,  if  the  delirium 
becomes  more  active,  the  tongue  more  dry,  the  skin 
hot  and  parched  ;  if  the  motor  spasms,  tremulous- 
ness,  subsultus,  etc.,  are  aggravated  by  alcohol,  it  is 
doing  harm. 

The  following  case,  occurring  in  Dr.  Draper's  ser- 
vice at  the  New  York  Hospital,  will  serve  very  effec- 
tually to  illustrate  the  power  of  alcohol  as  an  anti- 
pyretic : 

Boy,  13  years.  Admitted  Nov.  30.  Four  nights 
previous  the  patient  was  taken  with  severe  pain  in 
the  abdomen,  nausea,  and  vomiting,  followed  by  high 
fever,  with  thirst,  anorexia,  prostration,  etc.  Pulse, 


TYPHOID   FEVER.  IQI 

88 ;  respiration,  24  ;  temperature,  103°.  Patient  de- 
lirious. 

Dec  I.— P.  118  ;  R.  28  ;  T.  105°.  Spts.  vini  gall 
%  viii.  were  administered  during  the  day. 

2nd. — T.  103°.  Patient  delirious.  Spts.  vini  gall. 
§xii. 

•$d. — T.  102°.  Brandy  diminished.  In  the  even- 
ing: T.  106.°  Brandy  readministered  .as  before. 

4//z. — T.  100.4°.  n  A.M.,  temperature  nearly  nor- 
mal. Fever  aborted  ;  no  diagnosis  made. 

For  sustaining  the  heart  power,  besides  the  use  of 
stimulants,  digitalis  is  administered  as  indicated. 

In  the  management  of  the  accidents  of  typhoid 
fever,  the  most  careful  judgment  is  insisted  upon. 

Regarding  leeches,  blisters,  etc.,  in  his  experience 
no  benefit  is  derived  from  their  application.  Where 
perforation  of  a  blood-vessel  takes  place,  he  enjoins 
absolute  repose,  and  aims  to  control  the  diarrhoea  as 
well  as  the  patient's  desire  to  defecate.  To  accom- 
plish this,  opium  is  given  internally,  and  styptics  ad- 
ministered per  anum. 

As  to  the  value  of  phenic  acid  in  typhoid  fever,  so 
strongly  advocated  by  Dr.  De"clat,  this  plan  of  treat- 
ment has  been  employed  by  him  at  the  above  hos- 
pital, but,  from  the  results  obtained,  he  does  not  con- 
sider it  deserving  of  much  credit. 

During  convalescence,  DR.  DRAPER  advises  that 


IQ2  TYPHOID   FEVER. 

the  greatest  care  be  exercised,  from  danger  of  re- 
lapse, perforation,  and  its  serious  consequence.  There- 
fore rest  and  the  most  careful  attention  to  the  diet, 
are  always  insisted  upon. 

DR.  BEVERLY  ROBINSON  calls  attention  to  the 
great  importance  of  the  occurrence  of  sudden  car- 
diac failure,  in  this  disease.  He  believes,  from  very 
recent  practical  investigation,  that  at  times,  indeed 
quite  frequently,  there  is  a  sudden  and  considerable 
dilatation  of  the  cavities  of  the  heart,  more  particu- 
larly of  the  right  heart.  In  such  a  condition  coagula 
may  be  formed,  or,  if  free  and  strong  stimulation  be 
at  once  resorted  to,  the  period  of  danger  may  be 
tided  over,  and  only  partial  failure,  with  dangerous 
but  not  fatal  symptoms,  occur.  To  guard  against 
this  peril,  he  advises  that  all  unnecessary  fatigue 
should  be  absolutely  avoided,  during  the  course  of 
even  mild  cases  of  typhoid  fever.  The  patient  should 
not  be  allowed  to  rise  unassisted  in  bed,  or  to  sit  up 
but  a  few  minutes  on  any  occasion,  and  under  no  cir- 
cumstances until  convalescence  is  fully  established. 
Self-feeding,  or  any  act  which  calls  for  the  expendi- 
ture of  physical  energy,  and  which  can  be  prevented 
by  careful  nursing,  should  never  be  permitted.  He 
also  resorts  to  the  administration  of  heart  tonics  in 
exceedingly  moderate  doses,  from  a  comparatively 
early  stage  of  the  disease,  more  especially  if  the 


TYPHOID   FEVER.  193 

slightest  evidence  of  failure  of  the  heart  power  is 
exhibited.  Black  coffee  is  considered  by  him  to  be 
highly  valuable  as  a  stimulant,  and  he  insists  upon 
its  use  early.  In  addition  he  also  urges  the  employ- 
ment of  liquid  nourishment  in  the  most  concentrated 
form. 

DR.  F.  DELAFIELD  places  the  patient  upon  an  ex- 
clusively milk  diet,  with  confinement  to  bed.  For 
an  antipyretic  he  usually  prefers  cold,  either  in  the 
form  of  the  bath  or  the  pack.  Where  the  bowels 
are  inclined  to  be  loose,  he  administers : 

$.    Bismuthi  subnit.       .         . 

Pepsini     .         .         .         .         aa  gr.  iii-vi. 

M.  Sig.  Dose,  three  times  daily,  or  oftener  if  re- 
quired. 

If  constipation  prevails,  warm  enemata  containing 
ox  gall  or  castor  oil,  are  used  with  good  effect.  In 
the  later  stages  where  this  condition  exists,  he  pre- 
scribes the  ///.  aloes  et  myrrh.  No.  i-ii.  with  much 
benefit.  Stimulants  are  also  given,  usually  whiskey 
or  brandy  according  to  indications. 

In  cases  where  dysentery  supervenes,  he  directs 
that  the  bowels  be  freely  opened  with  : 

ijfc.    Ol.  ricini      .         .         .         .          3ii~3ss- 
Tinct.  opii  ....     gtt.  iii-viii. 

M.    Sig.  Dose,  according  to  age. 

Following  this,  he  administers  the  ipecac  treatment. 
13 


194  TYPHOID   FEVER. 

If  much  pain  is  present  opium  is  given  to  control  it. 
After  the  more  active  symptoms  have  subsided,  he 
generally  finds  it  of  advantage  to  put  the  patient  on 
the  use  of  the  following: 

IJ.    Tinct.  opii  deod.         .        .         3  i-  m.xx. 

Ol.  ricini ^  i. 

Mucilag q.s. 

Aq.  cinnamomi  ad    .         .         .  §  iv. 

M.     Sig.  3  ii-iv.  three  times  daily,  according  to  age. 

On  this  plan  the  results  are  usually  very  satisfac 
tory. 

In  resorting  to  cold  as  an  antipyretic,  DR.  W. 
H.  THOMSON  directs  that  the  patient  be  placed  in  a 
bath  of  75°-8o°,  and  the  water  gradually  cooled  down 
to  65°  or  60° ;  never  lower,  however.  At  the  same 
time,  cold  affusions  should  be  applied  continuously 
to  the  head.  Provided  the  fall  is  gradual,  that  is, 
one  degree  in  six,  four,  or  three  minutes,  the  bath  is 
continued  until  the  temperature  is  reduced  to  100°. 
If,  however,  the  temperature  falls  one  degree  in  two 
and  one-half  minutes,  he  stops  the  bath  when  the 
thermometer  reaches  101°  ;  for,  as  a  rule,  a  still  fur- 
ther reduction  of  i°  will  occur  after  the  bath  is  dis- 
continued. Again,  if  the  fall  in  temperature  be  one 
degree  in  two  minutes,  he  removes  the  patient  imme- 
diately, whatever  the  actual  temperature  may  be  at 
the  time  ;  for,  in  such  cases,  he  advises,  there  is  dan- 


TYPHOID   FEVER.  195 

ger  of  the  subsequent  fall  becoming  uncontrollable, 
reaching  perhaps  97°,  and  the  patient  pass  into  col- 
lapse. Should  such  a  condition  occur  at  any  time, 
he  at  once  orders  the  patient  wrapped  in  hot  blankets, 
hot  saucers  applied  to  the  epigastrium,  and  stimulants 
freely  administered.  Where,  from  any  cause,  the  bath 
is  impracticable,  the  cold  pack  is  used  ;  always,  how- 
ever, with  the  same  precautions. 

In  resorting  to  either  of  these  measures,  DR. 
THOMSON  directs  that  it  be  repeated  often  enough 
to  keep  the  temperature  below  the  point  of  danger. 
If  necessary,  he  administers  one  every  hour;  usually, 
however,  two  or  three  daily  are  sufficient,  in  which 
case  he  advises  that  one  should  be  so  timed  as  to  be 
given  just  before  the  highest  rise  of  the  fever  heat, 
generally  between  two  and  three  o'clock  in  the  after- 
noon. 

DR.  A.  H.  SMITH  uses  the  following  method  of 
administering  quinine  by  inunction,  and  finds  it  es- 
pecially serviceable  in  children : 

9-    Quiniae  sulphat 3  i. 

Acid,  oleic.  pur.        .         .         .  §  i. 

Ol.  olivae  .         .         .         .         .    §  ii. 

Dissolve  the  quinia  in  the  acid,  with  the  aid  of  a 
gentle  heat,  and  add  the  oil.  If  properly  prepared, 
the  solution  will  remain  clear. 

Sig.   For  inunction,  to  be  well  rubbed  in. 


IQO  TYPHOID   FEVER. 

This,  he  advises,  may  be  applied  once  or  twice 
daily  to  the  entire  surface,  or  oftener  if  required. 

DR.  AUSTIN  FLINT  directs  that  the  child  be  placed 
in  bed  and  on  a  milk  diet,  which  is  much  preferred 
by  him.  As  a  rule,  alcohol  is  also  given  in  moderate 
amount,  to  sustain  the  strength  of  the  patient,  to- 
gether with,  in  many  instances,  spts.  ammon,  aromat. 
For  an  antipyretic,  he  sometimes  employs  quinine  in 
large  doses,  but  usually  relies  more  upon  cold,  in 
form  of  the  bath,  pack,  or  sponging.  Of  these,  how- 
ever, he  places  greatest  reliance  upon  the  wet  pack, 
and  finds  this  measure  very  generally  successful, 
while  a  reduction  of  temperature  does  not  always 
follow  the  use  of  the  sponge  bath.  The  cold  bath, 
he  advises,  is  not  only  a  troublesome  method,  but  it 
also  frequently  produces  a  nervous  shock  to  the 
patient.  The  results,  moreover,  from  the  cold  sheet, 
that  is  to  say,  by  wrapping  the  body  in  a  wet  cloth 
and  sprinkling  with  cold  water,  he  finds  equally  as 
satisfactory  in  its  effect. 

In  many  cases  occurring  at  BELLEVUE  HOSPITAL, 
where  the  diarrhoea  is  excessive,  the  administration 
of  olei  tcrebinthince,gtt.  v-x,  every  three  or  four  hours, 
is  found  to  be  very  effectual  in  controlling  it.  If 
hemorrhages  occur  and  the  patient  passes  into  a 
condition  of  collapse,  turpentine  is  given  three  or 
four  times  daily,  in  large  doses,  ice  applied  to  the 


TYPHOID   FEVER.  197 

right  iliac  fossa,  and  sol.  morph.  sulph.  (U.  5V)  admin- 
istered in  sufficient  amount  to  afford  quiet,  together 
with  whiskey  3  ii-iii.  every  Jialf-liour.  Sometimes  these 
measures  are  successful  in  controlling  the  bleeding, 
and  the  patient  rallies.  Or,  if  the  hemorrhage  recurs 
and  is  more  profuse,  the  administration  of  turpentine 
is  increased  to  every  hour  or  every  two  hours,  and 
the  following  given : 

Ijfc.    Ergotini gr.  iii. 

Aquae  destil.         .         .        .         .          3  i- 

M.  Sig.  m.  v-viii.  hypodermically. 

Morphia  is  also  used  to  keep  the  patient  quiet, 
and  hypodermics  of  ether  in  doses  of  m.  v-xv.  once 
or  twice  daily,  ordered,  with  whiskey  as  before.  By 
these  means  of  treatment,  repeated  and  persisted  in 
as  occasion  requires,  the  crisis  is  sometimes  tided 
over. 

Where  there  is  much  insomnia,  with  restlessness, 
the  following  will  often  cause  the  child  to  fall  into  a 
quiet  and  refreshing  sleep : 

Ijfc.    Chloral,  hydrat.         .         .         .       gr.  xl. 
Aquae        .         .         .         .         .         .     ^  i. 

M.  Sig.  A  teaspoonful,  repeated  in  one  or  two 
hours,  to  a  child  of  six  to  eight  years. 

Or,  in  many  cases,  the  combination  of  potassium 
bromide  acts  very  favorably  in  controlling  the  cere- 
bral excitement ;  thus : 


198  TYPHOID   FEVER. 

JjL  Potass,  bromidi  gr.  x. 
Chloral,  hydrat.  ...  gr.  y. 
Aq.  anethi 3  ii. 

M.  Sig.  Dose,  every  four  to  six  hours,  to  a  child 
of  six  years. 

DR.  A.  L.  LOOMIS  directs  that  particular  attention 
be  paid  to  thorough  disinfection,  both  of  the  stools 
and  of  the  clothes  and  bedding.  The  room  should 
also  be  well  ventilated,  and  the  temperature  kept  at 
about  60°.  The  diet,  he  advises,  requires  especial 
care.  This  should  consist  exclusively  of  fluids,  and, 
in  his  experience,  milk  is  the  best  article  of  food,  to 
which  lime  water  may  be  added,  if  necessary,  to  allay 
any  irritability  of  the  stomach.  Regarding  broths, 
gruels,  etc.,  he  not  only  objects  to  their  use,  but 
considers  them  often  positively  harmful.  Fruits  are 
also  especially  interdicted  by  him.  In  mild  cases, 
where  the  fever  does  not  range  very  high,  he  often 
finds  that  this  is  all  that  is  needed,  beyond  an  occa- 
sional or  frequent  sponging  of  the  body  with  tepid 
or  cold  water. 

In  the  more  severe  forms,  his  chief  indications  for 
treatment  are  to  lower  the  temperature,  maintain  the 
heart's  action,  and  support  the  nutrition  of  the 
patient.  As  an  antipyretic  in  typhoid  fever,  he  con- 
siders the  use  of  cold  in  form  of  the  bath,  pack,  etc., 
one  of  the  most  efficient.  Ice-bags  to  the  abdomen 


TYPHOID   FEVER.  199 

and  to  the  head,  and  ice-water  enemata  are  also,  in 
certain  cases,  often  found  of  marked  value.  Care  is 
advised,  however,  in  the  use  of  cold,  and  in  all  cases 
he  believes  it  unwise  to  resort  to  this  measure  after 
the  second  week. 

Quinine  in  large  doses,  is  found  by  DR.  LOOMIS  to 
render  valuable  service  in  the  reduction  of  tempera- 
ture, and  in  many  instances  this  alone  is  employed. 
In  very  severe  cases,  however,  his  .custom  is  to  use 
both  cold  and  quinine ;  that  is  to  say,  after  the  body 
temperature  has  been  lowered  to  ioi°-iO2°  by  the 
cold  bath,  he  gives  an  antipyretic  dose  of  quinine  ; 
thus  maintaining  the  benefit  derived  from  the  bath, 
and  postponing  the  subsequent  exacerbation  of  the 
fever.  The  following  formulae  are  very  highly 
esteemed  by  him  for  hypodermic  administration  : 

]jfc.    Quiniae  disulph.  gr.  1. 

Acid,  sulphuric.  .  m.  v. 

Acid,  carbol m.  ii. 

Aquae  destil §  i. 

M. 

Or: 

$.    Quiniae  sulphat.    .  .         3i. 

Acid,  hydrobrom.          .         .         .        3  ii. 
Aquae  destil.          .         .         .  3  vi. 

M. 

Of  these,  the  latter  has  been  more  recently  used 


20O  TYPHOID   FEVER. 

by  him,  and  is  much  preferred.  After  the  second 
week,  however,  should  quinine  alone,  or,  in  certain 
cases,  the  use  of  the  cold  pack  in  conjunction,  fail  to 
control  the  fever,  unless  contraindicated  by  the  pulse 
he  often  finds  powdered  digitalis,  in  doses  amounting 
to  gr.  v-x.  during  the  twenty-four  hours,  in  combina- 
tion with  quinine,  of  excellent  service. 

For  maintaining  the  heart's  action,  stimulants  are 
given  as  indicated.  But  he  advises  that  alcohol 
should  be  used  cautiously,  and  always  with  discrimi- 
nation. If  its  administration  is  of  doubtful  advis- 
ability, he  directs  that  it  be  withheld  until  the 
indications  for  its  use  become  stronger ;  and  in  all 
instances,  he  insists  that  the  effects  be  carefully 
watched,  and  its  use  suspended  if  no  benefit  follows. 
At  a  period  of  crisis,  however,  free  stimulation  is 
often  followed  by  the  most  gratifying  results. 

To  meet  the  special  symptoms  and  accidents  oc- 
curring in  the  course  of  the  disease,  various  means 
are  employed  according  to  circumstances.  If  the 
headache  is  very  severe,  warm  water  fomentations 
are  usually  found  very  beneficial.  Should  this  fail, 
or  the  headache  be  followed  by  severe  nervous  phe- 
nomena, opium  is  given  cautiously  in  small  doses 
unless  contraindicated  by  the  pupil.  Or  small  doses 
of  chloral,  repeated  in  two  hours  if  necessary,  often 
afford  relief. 


TYPHOID   FEVER.  2OI 

A  moderate  diarrhoea  in  the  early  stage,  DR. 
LOOMIS  believes  may  be  let  alone.  Coming  on 
during  the  third  or  fourth  week,  he  endeavors  to 
check  it,  placing  the  greatest  reliance  upon  opium 
for  this  purpose.  In  his  experience  astringents, 
either  alone  or  combined  with  opium,  are  of  little  or 
no  service.  Regarding  the  use  of  cathartics  in  the 
early  part  of  the  disease  when  constipation  is  pres- 
ent, he  advises  that  they  are  very  likely  to  do  harm  ; 
in  his  opinion  they  weaken  the  patient,  increase  the 
local  intestinal  lesions,  and  may  cause  perforation 
and  peritonitis.  For  the  tympanitis,  he  derives  most 
benefit  from  the  use  of  turpentine  stupes.  Intestinal 
hemorrhages  in  the  early  stage,  when  mild  in  char- 
acter, require  no  treatment,  as  a  rule ;  moreover,  he 
advises  that  profuse  hemorrhages  may  often  be  pre- 
vented by  keeping  the  patient  in  bed.  Coming  on 
in  the  third  or  fourth  week,  however,  or  later,  prompt 
measures  are  immediately  resorted  to  ;  semi-narcotism 
is  induced  by  the  use  of  opium,  and  perfect  rest  and 
quiet  enjoined.  Astringents  he  considers  of  ques- 
tionable service.  The  occurrence  of  peritonitis  is 
met  by  opium,  as  in  cases  of  local  peritonitis.  Pul- 
monary complications  are  treated  as  usual. 

During  convalescence,  DR.  LOOMIS  directs  the 
strictest  attention  to  the  diet.  The  food  is  given 
frequently  in  small  amounts,  consisting  of  milk, 


2O2  SCARLET   FEVER. 

cream,  broths,  etc.,  avoiding  solids,  particularly  fruits 
and  vegetables,  and  an  advance  to  the  ordinary  arti- 
cles of  diet  gradually  and  cautiously  made.  If  con- 
valescence is  retarded,  he  finds  the  use  of  tonics,  cod 
liver  oil,  and  iron,  very  beneficial.  The  following  is 
a  favorite  tonic  mixture  with  him : 

]pL    Quiniae  sulph.         .         .        .        gr.  xxx. 

Ac.  sulphuric,  dil.  .         .         .  q.  s. 

Aquae j§  ii. 

Tinct.  ferri  chlor §  ss. 

Spts.  chloroformi  .         .        .        .      3vi. 

Glycerinae  q.  s.  ad          .        .  §  iv. 

M. 


SCARLET   FEVER. 


In  mild  cases,  DR.  ALOXZO  CLARK  often  finds  that 
medicines  are  not  required  at  all,  beyond  a  moderate 
amount  of  champagne  daily.  In  severer  forms  of 
the  disease,  for  the  throat  affection,  he  uses  calomel, 
silver  nitrate,  etc.;  but  in  children  who  are  old 
enough,  he  believes  that  gargling  the  throat  fre- 
quently writh  cold  water,  or  cold  carbonic  acid  water 
is,  in  many  instances,  the  best  means  of  treatment. 

•h3JJ< 


SCARLET   FEVER.  2C>3 

Where  false  membrane  is  present  he  prefers  the 
spray  of  lime  water,  thrown  into  the  child's  mouth 
during  inspiration,  and  allowing  it  to  run  down  the 
fauces.  If  the  disease  is  complicated,  by  diphtheria, 
he  places  greatest  reliance  on  the  use  of  the  lime 
water  spray,  continued  and  repeated  as  often  as  indi- 
cated ;  this  measure  is  considered  exceedingly  effica- 
cious. In  regard  to  cold  as  an  antipyretic,  he 
recommends  the  wet  sheet  as  very  serviceable,  and 
frequently  resorts  to  it,  although  quinine  is  employed 
by  him  with  much  favor. 

In  those  cases  characterized  by  hemorrhagic 
eruption,  he  places  the  patient  under  the  influence 
of  quinine,  combined  with  the  free  administration  of 
the  vegetable  acids,  and  an  abundance  of  nutritious 
food.  Regarding  the  kidneys,  if  oedema  occurs,  he 
directs  that  the  child  be  given  a  hot  bath,  and  imme- 
diately afterward  removed  to  a  warm  room  and  kept 
in  bed,  with  sufficient  covering  to  induce  a  constant, 
gentle  perspiration  day  after  day.  This  plan  has 
been  found  by  him  to  be  the  most  successful  method 
of  treatment.  DR.  CLARK  also  advises  that  the 
bowels  be  kept  free,  not  vigorously  purged,  but  that 
a  laxative  be  given  as  often  as  necessary,  and  an 
abundance  of  drink  supplied,  together  with  unirrita- 
ting  food.  When  indicated,  an  opiate  or  Dover's 
powder  is  also  administered. 


2O4  SCARLET    FEVER. 

In  the  severer  type  of  this  disease,  for  the  relief  of 
the  high  temperature,  DR.  J.  LEWIS  SMITH  resorts 
to  the  use  of  water,  cold  or  lukewarm,  applied  in  the 
form  of  sponging,  the  pack,  or  sometimes  the  full 
bath,  whenever  the  thermometer  registers  above 
103°.  This  he  regards  as  one  of  the  most  valuable 
agents  that  can  be  employed,  for  reducing  tempera- 
ture and  affording  general  relief  to  the  patient.  To 
control  the  nervous  complications,  he  administers 
large  and  frequently  repeated  doses  of  potassium 
bromide,  and  usually  very  effectually.  Where,  how- 
ever, this  fails,  he  finds  that  the  use  of  chloral 
hydrate,  by  the  rectum,  will  almost  surely  prove 
successful.  For  this  purpose  he  employs  a  small 
glass  syringe,  giving  the  following : 

I£.    Chloral,  hydrat.         ...  gr.  v. 

Aquae        .....  3  ii- 

M.    Sig.     To  a  child  of  one  to  three  years. 

Regarding  inunction,  he  considers  it  very  service- 
able, especially  during, the  desquamative  stage,  pre- 
ferring vaseline  or  carbolized  applications.  As  to 
prophylaxis,  he  believes  there  is  no  remedy  which 
can  prevent  the  spread  of  the  disease. 

In  the  declining  stage  of  scarlatina.  DR.  SMITH 
often  derives  great  benefit  from  placing  the  child 
upon  the'use  of  the  following : 

1$.    Ammon.  carb.     .         .         .         ,         3ss. 


SCARLET   FEVER.  2O5 

Ferri  et  ammon  cit.    .         .         .         3  ss. 
Syrupi         .         .         .         .         .          §  iv. 

M.    Sig.    3  i-ii.  every  second  or  third  hour. 

If  the  disease  is  complicated  by  diphtheria,  he  ad 
vises  that  stimulation  is  demanded  ;  in  these  cases, 
he  usually  gives  brandy  in  doses  of  3  i-  every  half -hour, 
to  a  child  of  three  years. 

For  prophylaxis,  DR.  A.  L.  LOOMIS  employs  those 
measures  necessary  in  other  contagious  fevers.  The 
patient  is  isolated,  the  room  well  ventilated,  and  a 
thorough  disinfection  of  both  clothes  and  excrements 
carefully  attended  to.  Fresh  air  is,  in  his  opinion, 
of  the  greatest  value  as  a  prophylactic  agent. 

His  medicinal  treatment  is  chiefly  symptomatic. 
As  an  antipyretic,  he  considers  quinine  in  large  doses 
most  efficient.  The  cold  bath  is  employed,  how- 
ever, where  the  temperature  runs  high,  and  the  ner- 
vous phenomena  present  demand  the  adoption  of 
urgent  measures.  But  in  all  instances,  he  directs 
that  the  patient  be  sponged  at  frequent  intervals  ; 
this  affords  comfort  and,  at  the  same  time,  relieves 
the  intense  burning  which  is  usually  present,  espec- 
ially if  a  tepid  saline  water  be  used.  When  the  pro- 
cess of  desquamation  begins,  he  advises  that  a  warm 
bath  be  administered  once  or  twice  daily,  and  carbol- 
izcd  soap  used  over  the  entire  body.  As  regards  the 
use  of  stimulants,  these,  he  finds,  are  sometimes  in- 


2O6  SCARLET   FEVER. 

dicated  even  from  the  early  stage  of  the  disease,  par- 
ticularly in  cases  where  marked  nervous  symptoms 
are  present,  together  with  failure  of  the  vital  powers  ; 
and  indeed,  in  certain  instances,  free  stimulation  con- 
stitutes almost  his  sole  reliance. 

He  also  directs  that  especial  guard  be  made  against 
complications.  These  are  carefully  watched  for,  and 
met  by  suitable  means.  For  the  throat,  he  finds 
cold  carbonic  acid  water,  or  pieces  of  cracked  ice, 
most  serviceable ;  particularly  in  the  early  stage. 
Later  on,  when  there  is  considerable  infiltration  pres- 
ent, he  prefers  the  use  of  hot  applications  extern- 
ally, covered  with  oil-silk,  and  combined  with  steam 
inhalations  and  warm  gargles,  as  of  greatest  benefit. 
If  ulcers  are  present,  these  are  treated  very  satisfac- 
torily with  carbolic  acid  or  potassium  chlorate,  in  form 
of  the  spray.  Anodyne  applications,  by  means  of 
the  spray,  are  also  found  to  give  much  relief. 

When  evidences  of  kidney  lesions  are  manifest, 
DR.  LOOMIS  resorts  to  the  immediate  application  of 
clips,  three  or  four  in  number,  followed  by  the  use  of 
hot  fomentations.  Combined  with  these  measures, 
he  also  directs  that  the  body  be  covered  with  flannel 
and  hot  baths  employed,  together  with  the  internal 
administration  of  diuretics.  Of  the  latter  he  pre- 
fers digitalis.  Frequent  draughts  of  water  are  also 
^iven.  If  these  fail  in  reducing  the  anasarca,  he  then 


SCARLET   FEVER.  2O/ 

administers  calomel  in  combination  with  the  diuretic, 
continuing  this  for  two  or  three  days,  and  often  with 
the  most  gratifying  result.  If  convulsions  are  immi- 
nent, or  present,  opium  is  given,  affording  relief  to 
these  symptoms  as  well  as  producing  diaphoresis, 
which  is  sometimes  of  vital  importance  in  this  con- 
dition. 

For  a  gargle,  DR.  G.  M.  LEFFERTS  uses  the  fol- 
lowing : 

]pL    Glycerit.  ac.  carbol.  .         .          3i-ii. 

Aquae §x. 

M. 
Or: 

P.    Acid,  acetic 3iiss. 

Glycerinae         ....  3  iii- 

Aquae ^x. 

M. 

DR.  F.  A.  BURRALL  finds  the  following  very  ser- 
viceable : 

Ijfc.    Acid,  carbol.  .         .         .         gr.xx. 

Glycerinae         ....  §  i. 

Sodii  chloridi  ...  3  i- 

Aquae  ad  ....          §  viii. 

M.    Sig.     Gargle. 

DR.  D.  LEWIS  has  used  the  infusion  of  digitalis 
in  the  treatment  of  scarlet  fever,  in  a  large  number 
of  cases,  and  with  markedly  beneficial  and  uniformly 


208  SCARLET   FEVER. 

successful  results.  By  this  means,  not  only  is  the 
frequency  of  the  pulse  lessened,  the  temperature 
lowered,  and  its  effects  on  the  circulation  of  the  kid- 
neys exhibited,  but  he  also  finds  that  the  tendency 
to  exudation  in  all  glandular  tissue  is  reduced  to  the 
minimum,  by  its  use.  For  these  cases,  he  considers 
the  infusion  of  the  best  English  leaves,  the  most  re- 
liable preparation.  The  tincture  is,  in  his  experience 
unsatisfactory.  In  regard  to  the  administration,  he 
directs  that  this  be  commenced  at  the  earliest 
possible  stage  of  the  disease,  before  those  tissue 
changes  have  occurred  which  it  is  intended  to 
prevent  as  well  as  cure.  He  usually  gives  the 
following : 

P.    Infus.  digitalis      .         .         .         .         3  i- 

Sig.  Dose,  every  four  hours,  to  a  child  of  five 
years. 

This,  he  finds,  is  a  safe  and  generally  an  efficient 
dose.  Should,  however,  the  pulse  and  temperature 
be  unaffected  by  it,  he  increases  the  amount  to  even 
3  ii.  if  necessary,  but  advises  that  its  effects  be  care- 
fully watched,  and  the  dose  reduced  as  soon  as  the 
desired  result  is  produced.  Unless  the  pulse  be- 
comes less  frequent  than  it  should  be,  he  continues 
the  administration  two  or  three  times  daily,  until  the 
end  of  the  third  week.  This  plan  of  treatment  has, 
in  numerous  instances,  caused  a  decided  fall  in  the 


SCARLET   FEVER.  2OQ 

pulse  and  temperature  within  twenty-four  hours,  and 
the  most  favorable  results  have  followed. 

For  the  throat  affection,  DR.  LEWIS  prescribes  the 
following,  a  favorite  with  him  and  usually  very  ef* 
ficient : 

IJ.  Potass,  chlorat.  .  .  .  .  3  i- 
Tinct.  ferri  chlor.  .  .  .  3  ii. 
Glycerinae  .  .  .  .  §i. 

Aquae  q.s.  ad         ....     §  viii. 

M.     Sig.     A  teaspoonful  every  half-hour. 

If  exudation  occurs  in  the  fauces,  he  also  uses  this 
mixture  applied  by  the  atomizer  every  twenty  min- 
utes. A  water  sponge  batJi  is  also  given  more  or  less 
frequently,  according  to  the  degree  of  the  fever,  and 
inunctions  of  olive  oil  applied  over  the  entire  body 
at  least  twice  daily,  and  continued  until  desquama- 
tion  is  complete.  The  diet  he  requires  to  be  strictly 
of  milk,  particularly  on  account  of  its  diuretic  effect. 
In  his  experience,  under  this  treatment,  no  case  of 
suppuration  of  cervical  or  other  glands  has  oc- 
curred. 

Regarding  the  nephritis,  DR.  A.  JACOBI  has  suc- 
ceeded in  curing  a  number  of  cases  by  the  following 
method.  He  confines  the  child  to  bed  and  directs 
that  a  hot  batJi  be  given  twice  daily,  to  produce  free 
diaphoresis ;  or  sometimes  the  hot  pack  is  used  in- 
stead. In  other  instances,  where  the  heart's  action 
H 


210  SCARLET   FEVER. 

is  good,  he  employs  the  hypodermic  injection  of  pi- 
locarpine,  given  two  or  three  times  in  the  twenty-four 
hours ;  thus  inducing  an  abundant  perspiration.  In 
conjunction  with  this,  he  also  administers  alcohol  in 
sufficient  quantity  to  counteract  the  depression  on 
the  heart,  caused  by  the  pilocarpine.  By  this  means, 
he  occasionally  gives  as  many  as  eight  injections  in 
twenty-four  hours,  always  taking  care  to  see  that  the 
child  is  well  stimulated.  This  heroic  plan  is,  how- 
ever, not  advised  by  him  in  all  cases.  In  addition  to 
the  pilocarpine,  he  sometimes  prescribes  gallic  and 
tannic  acid  in  doses  of  gr.  v-xv.,  daily,  with  very 
favorable  effect.  Toward  the  later  stages,  he  finds 
the  administration  of  iron  often  of  great  service, 
when  there  is  much  albumen  in  the  urine.  The  cau- 
tious use  of  the  salines  is  also  resorted  to,  keeping 
the  bowels  gently  open. 

At  the  NEW  YORK  HOSPITAL,  the  following  solu- 
tion of  pilocarpine  is  kept  for  hypodermic  use  : 

IJ.    Pilocarpiae  mur.          .         .         .         gr.  i. 
Aq.  destil.  carbol.      .         .         .          m.  1. 

M. 

DR.  J.  H.  RlPLEY  finds  that  in  the  majority  of 
cases  of  scarlatinal  nephritis  the  tendency  is  to  re- 
covery. His  treatment  varies  somewhat  according 
to  the  special  symptoms,  and  the  different  complica- 
tions arising  in  individual  cases.  In  mild  attacks,  he 


SCARLET   FEVER.  211 

directs  that  the  child  be  put  to  bed  at  once,  in  a  room 
the  temperature  of  which  is  maintained  at  7O°-75°, 
and  the  atmosphere  kept  in  a  moistened  condition. 
All  exposure  to  cold  is  also  to  be  carefully  avoided. 
A  mild  laxative  is  given,  usually  a  combination  of 
magnesia,  senna  and  rliubarb,  keeping  up  a  somewhat 
free  action  of  the  bowels ;  the  use  of  hydragogues 
is,  however,  objected  to  by  him.  A  diaphoretic  is 
also  administered,  for  which  purpose  he  prefers  the 
liquor  ammon.  acetatis.  In  addition  to  these  meas- 
ures, the  diet  is  made  simple  and  nutritious,  alter- 
nating with  milk,  beef-tea,  buttermilk,  broths,  etc. 

In  severe  cases,  where  there  is  partial  or  complete 
suppression  of  the  urine,  he  discountenances  the  use 
of  active  diuretics  in  the  earlier  stage  of  the  disease, 
with  the  view  of  washing  out  the  debris.  In  his  ex- 
perience the  opposite  result,  with  increased  conges- 
tion of  the  already  surcharged  kidney,  obtains,  and 
he  considers  their  employ  worse  than  useless.  When, 
however,  the  disease  is  subsiding,  he  then  administers 
these  remedies  with  marked  benefit.  His  plan  of 
treatment,  and  on  which  he  places  the  greatest  reli- 
ance, is  to  induce  a  free  perspiration  by  means  of  the 
moist,  ivarm  pack,  applied  for  at  least  two  hours. 
This  measure  he  finds  highly  efficacious,  and  believes 
it  to  be  superior  to  any  other  means.  In  bad  cases, 
he  repeats  the  pack  several  times  during  the  twenty- 


212  SCARLET  FEVER. 

four  hours,  and,  if  necessary,  every  day  for  a  number 
of  days.  In  this  respect,  he  cautions  that  great  care 
must  be  exercised,  to  avoid  any  exposure  to  cold 
during  the  intervals.  Should  the  child  prove  refrac- 
tory, force  is  used  ;  the  hands  and  arms  are  tied  and 
the  coverings  secured  by  safety  pins,  or  other  means  ; 
or,  in  many  instances,  he  prefers  to  put  the  child 
under  the  influence  of  morphine,  for  this  purpose. 
On  removing  the  patient  from  the  pack,  the  body  is 
thoroughly  rubbed  with  a  coarse  towel  until  the  sur- 
face is  dry.  Regarding  the  warm  bath,  DR.  RlPLEY 
objects  to  its  use  on  account  of  the  general  tendency 
to  cause  exhaustion,  if  prolonged  or  frequently  re- 
peated. Moreover,  he  finds  that  many  children 
are  greatly  afraid  of  it,  and  alarming  syncope  is 
often  produced  by  this  means.  In  older  children, 
the  hot  air  bath  is  occasionally  substituted  for 
the  pack,  although  he  considers  it  far  less  prac- 
ticable. 

Dry  cupping  is  also  resorted  to,  but  he  directs  that 
the  cups  be  removed  before  stagnation  and  rupture 
of  the  capillaries  occur.  As  a  rule,  they  are  not  al- 
lowed to  remain  on  longer  than  five  or  ten  minutes, 
and  in  delicate  and  nervous  children  he  usually  finds 
it  better  to  administer  chloroform^  while  applying 
them.  In  some  cases,  instead  of  cups,  but  more  fre- 
quently following  them,  he  applies  lar'gc  hot  poultices 


SCARLET   FEVER.  213 

over  the  parts,  often  mixing  digitalis  leaves  with  the 
meal,  very  efficaciously. 

For  internal  medication,  after  perspiration  is  in- 
duced by  these  means,  DR.  RlPLEY  keeps  up  a  gen- 
tle moisture  of  the  skin  by  administering  the  following: 

IJ.    Ext.  jaborandi  fl.         .         .         gtt.  v-xx. 
Aquae          ......  q.s. 

M.    Sig.   Dose,  every  two  hours,  according  to  age. 

This,  he  finds,  is  a  much  more  serviceable  way  of 
giving  the  drug,  than  by  larger  doses  and  at  longer 
intervals.  If  the  temperature  is  high  and  the  pulse 
full  and  strong,  he  gives  tinct.  veratri  viridis  in  small 
doses  every  two  hours,  with  marked  benefit,  and  also 
with  good  effect  on  the  kidneys.  Aconite  he  finds 
less  certain  in  its  action,  although  not  so  likely  to 
cause  vomiting,  and  attended  with  less  danger  from 
prolonged  use.  If  there  is  much  restlessness  pres- 
ent, morphia  is  employed. 

Should  excessive  oedema  occur,  with  general  an- 
asarca,  and  diaphoresis  and  catharsis  prove  unavail- 
ing, a  few  small  punctures  are  made  in  the  lower  part 
of  the  legs,  and  often  very  successfully  in  causing  re- 
moval of  the  fluid.  As  a  rule,  however,  he  rarely 
finds  this  procedure  necessary  in  acute  cases.  Where 
pulmonary  oedema  occurs,  he  resorts  to  immediate 
dry  cupping,  together  with  the  application  of  large 
hot  poultices  over  the  entire  thorax. 


214  SCARLET   FEVER. 

In  treating  the  ursemic  symptoms  most  common  in 
children,  viz.  :  gastric  irritation,  painful  and  exhaust- 
ing diarrhoea,  extreme  restlessness,  etc.,  DR.  RiPLEY 
cautions  against  the  danger  of  inducing  excessive 
purgation,  especially  by  mercurials  ;  thus  increasing 
the  irritability  of  the  stomach,  impairing  the  nutri- 
tion, and  causing  loss  of  strength.  In  his  experience, 
producing  more  than  two  or  three  liquid  passages 
daily  is  harmful.  For  the  gastric  trouble,  he  ad- 
vises the  most  careful  attention  to  diet,  giving  the 
food  in  small  quantities  at  a  time;  a  teaspoonful 
every  fifteen  minutes,  he  finds,  will  be  retained,  when 
a  tablespoonful  every  hour  is  vomited.  For  this  pur- 
pose, koumyss,  milk  and  lime  \vater,  clam  broth,  or 
grated  smoked-beef,  are  preferred  by  him.  If  pros- 
tration is  a  prominent  symptom,  brandy  and  ice-water, 
or  champagne,  is  given  as  indicated.  Or,  in  many 
cases,  he  considers  the  following  almost  a  specific, 
prescribing  it  with  greatest  benefit : 

$.    Sol.  morphias  sulph.  (U.  S.)     .    gtt.v-xx. 

Sig.  Dose,  every  three  or  four  hours. 
This  is  administered  either  hypodermically  or  by  the 
stomach.  Or,  sometimes  a  mixture  of  a  few  drops 
of  chloroform  with  paregoric  and  syrup  of  acacia, 
does  very  well.  In  others,  he  uses  the  following 
most  satisfactorily: 

IJ,.     Chloral,  hydrat.         .         .         .    gr.v-xv. 


SCARLET  FEVER.  21$ 

Aquae %ss-i, 

M.    Sig.     Dose,  by  the  rectum. 

To  control  the  diarrhoea,  he  generally  begins  with 
a  small  purgative  dose  of  calomel  and  compound 
jalap  powder,  and  then  employs  a  mixture  of  opium  t 
tannic  acid  and  cinnamon  water,  to  hold  it  in  check  ; 
avoiding,  however,  any  tendency  to  produce  consti- 
pation. If  dysentery  is  present,  he  first  administers 
a  large  enema  of  hot  water,  thoroughly  washing  out 
the  gut  and  relieving  the  congestion,  after  which  he 
gives  the  following : 

$.    Tinct.  opii  .  .         .      gtt.iii-x. 

Aquae  ferv.        .          .  ^ ss- 

M.    Sig.    Dose,  as  an  enema,  according  to  age. 

This  latter  he  repeats  after  each  passage,  the  hot 
water  injection  being  employed  two  or  three  times 
daily.  Where  the  laudanum  enema  is  not  retained, 
opium  in  some  form,  either  alone  or  with  calomel, 
is  employed. 

For  the  restlessness,  DR.  RlPLEY  usually  finds  this 
symptom  yield  promptly  to  chloral  hydrate  particu- 
larly when  combined  with  small  doses  of  morphine. 


2l6  MEASLES. 


MEASLES. 

For  mild  cases,  DR.  ALOXZO  CLARK  finds  that 
hardly  any  treatment  is  necessary.  The  home 
remedy,  catnip  tea,  he  considers  about  as  good  as 
anything.  In  the  severer  forms  of  the  disease,  asso- 
ciated with  complications,  more  urgent  measures  are 
adopted.  In  the  hemorrhagic  variety,  he  adminis- 
ters iron  and  the  vegetable  acids,  together  with  the 
supporting  effects  of  quinine  and  nutritious  food. 
Should  gangrene  occur,  quinine,  in  his  experience, 
renders  the  greatest  service,  combined  with  the  free 
exhibition  of  stimulants.  In  the  malignant  form, 
however,  he  finds  medicinal  remedies  have  little  or 
no  influence  over  the  disease.  Ergot,  he  thinks,  may 
possibly  afford  some  benefit,  from  its  control  over 
the  capillary  circulation.  Cold,  applied  both  to  the 
body  and  to  the  head,  he  uses  very  effectually  as  an 
antipyretic,  when  called  for.  Should  anasarca  occur, 
he  resorts  to  the  same  measures  employed  in  his 
treatment  of  scarlatina.  For  the  ophthalmia  which 
sometimes  follows  an  attack  of  measles,  DR.  CLARK 
recommends  the  application  around  the  eyes  of  an 
ointment  of  veratria,  thus  : 

9,.    Veratriae  gr.  viii. 


MEASLES.  2  I  / 

Adipis  prep.            .         .         .  5  *• 

Ol.  olivae 3  ss. 

M. 

This  he  uses  with  the  utmost  satisfaction. 

As  prophylactic  measures,  DR.  A.  L.  LOOMIS 
directs  that  the  child  be  placed  in  a  separate  room, 
and  an  abundance  of  fresh  air  obtained  ;  together 
with  disinfection  of  the  clothing,  attention  to  clean- 
liness, etc.,  and  good  hygiene.  In  mild  cases,  very 
little  is  done  in  the  way  of  treatment.  The  room 
is  darkened,  good  ventilation  secured,  avoiding 
draughts  and  all  exposure,  and  the  patient  placed 
on  a  milk  diet  with  occasional  broths.  The  fever, 
where  it  is  slight  in  degree,  is  disregarded,  or  con- 
trolled by  frequent  tepid  sponging,  which  also  allays 
the  itching  and  burning  of  the  skin.  Where  there 
is  much  thirst,  this  is  relieved  by  permitting  the 
child  to  drink  freely  of  cold  water,  in  small  amounts. 
In  these  cases,  as  a  rule,  he  objects  to  the  use  of 
stimulants  in  the  early  stage,  and  advises  that  very 
serious  results  may  follow  their  administration. 
When,  however,  prostration  is  marked,  and  with 
the  typhoid  condition  present,  the  strength  of  the 
patient  must  be  supported,  and  stimulants  are  often 
required  from  the  onset  of  the  disease.  If  there 
is  considerable  restlessness,  opiinn  is  given  in  small 
doses  ;  usually  Dover's  powder. 


2l8  MEASLES. 

Where  the  disease  runs  a  severe  course,  and  the 
fever  calls  for  more  active  measures,  DR.  LOOMIS 
places  most  reliance  upon  quinine,  as  an  antipyretic. 
He  uses  the  sponge  bath,  however,  very  effectually, 
but  objects  to  the  cold  bath  from  fear  of  pulmonary 
complications.  These,  he  advises,  should  in  all 
cases  be  especially  guarded  against ;  and  when  bron- 
chitis is  present,  or  as  soon  as  laryngeal  symptoms 
are  manifest,  and  respiration  interfered  with,  he 
immediately  resorts  to  inhalations  of  vapor,  and 
continues  them  so  long  as  evidence  of  any  obstruc- 
tion to  the  breathing  exists.  The  importance  of 
this  measure,  he  believes,  cannot  be  over-estimated. 
The  following  is  a  most  excellent  cough  mix- 
ture, and  is  used  very  extensively  with  children  at 
BELLEVUE  HOSPITAL  (also  at  the  INFANTS'  HOS- 
PITAL) : 

IjL    Tinct.    opii  camph. 

Spts.  ammon.  arom.    .         .         .     aa  §  i. 

Ext.  ipecac,  fl.  .         .         .3  ss. 

Syr.  pruni virg §  i. 

Aquae  q.s.  ad         ....      §  v"i- 
M.     Sig.  A  teaspoonful. 

In  cases  of  so-called  German  Measles,  or  Epi- 
demic Roseola,  his  treatment  consists  mainly  in 
careful  attention  to  the  diet,  etc.,  and  the  avoidance 
of  exposure.  Any  catarrhal  affections  which  are  apt 


VARIOLA.  219 

to  arise  in  the  course  of  the  disease,  are  carefully 
guarded  against,  and  when  occurring,  receive  prompt 
attention.  For  the  itching,  which  is  sometimes  in- 
tolerable, he  finds  sponging  with  tepid  water  very 
efficient,  as  well  as  in  relieving  the  febrile  symptoms. 
In  certain  cases,  he  also  prescribes  tonics,  iron,  and 
cod  liver  oil  when  indicated,  with  good  effect,  but 
usually  he  finds  that  the  disease  runs  a  mild  course, 
and  recovers  with  no  untoward  symptoms. 


VARIOLA. 

(SMALL  POX.) 


DR.  J.  N.  McCHESNEY  (late  Attending  Physician 
to  the  Hospital  for  Contagious  Diseases)  finds  that 
mild,  discrete  cases  require  little  or  no  treatment, 
except  the  usual  attention  to  hygiene  and  diet. 
This  latter,  in  the  early  period  of  the  disease,  is 
iriade  simple,  consisting  of  milk,  rice,  cornstarch, 
etc.  In  these  patients,  when  contact  with  other 
persons  can  be  prevented,  exercise  in  the  open  air  is 
also  found  beneficial. 

During  the  first  few  days,  in  the  early  stage,  he 
administers  cooling  acidulated  drinks  for  the  fever, 


220  VARIOLA. 

together  with  sponging  the  body  with  cool  or  tepid 
water;  this  also  serves  to  render  the  patient  more 
comfortable.  Quinine  he  considers  of  little  or  no 
use  as  an  antipyretic,  and  finds,  moreover,  that  it  is 
rejected,  as  a  rule,  and  only  adds  to  the  irritability 
of  the  stomach.  If  constipation  is  present,  an 
enema  or  mild  laxative  is  given,  avoiding  active 
catharsis.  For  this  purpose,  the  citrate  of  magnesia 
is  found  very  agreeable  and  efficient ;  or  sometimes 
seidlitz  powders,  or  one  of  the  aperient  waters,  are 
used.  These  also  tend  to  relieve  the  nausea  and 
vomiting.  Where  diarrhoea  is  prominent,  mistura 
cretae  is  ordered,  either  alone  or  with  one  of  the 
vegetable  astringent  tinctures.  Or,  in  many  cases, 
the  following  is  used  by  him  with  the  greatest  satis- 
faction : 

$.    Ext.  coto  fl m.  x. 

Syrupi  aromat.  .         .         .  q.  s. 

M.    Sig.    Dose,  every  half  hour. 

This  he  gives  until  three  doses  have  been  taken, 
which  is  usually  found  sufficient.  The  nausea  and 
vomiting,  however,  is  sometimes  very  persistent  and 
distressing.  To  relieve  this  symptom,  in  some  in- 
stances small  lumps  of  ice,  swallowed  whole,  are  of 
service.  In  others,  lime  water,  or  carbonic  acid 
water  in  small  quantities  is  most  efficacious.  Or, 
morphia  hypodermically  over  the  region  of  the 


VARIOLA.  221 

stomach  is  often  used  with  the  greatest  success. 
Counter-irritation,  in  the  shape  of  mustard  poultices, 
though  usually  effectual,  is  objected  to  on  account 
of  inducing  vesication.  For  the  headache,  he  applies 
cold  cloths ;  or,  occasionally  hot  cloths,  as  hot  as 
can  be  borne,  are  more  serviceable.  If  there  is 
much  restlessness  and  delirium,  he  gives  the  bro- 
mides combined  with  chloral  in  an  aromatic  vehicle, 
with  good  effect ;  or,  if  necessary,  morphia  is  used. 
To  relieve  the  intense  pains  in  the  back,  various 
means  are  employed.  Sometimes  the  sponging  and 
bathing  resorted  to  for  the  temperature,  is  found 
beneficial.  Or  the  application  of  a  sponge  wrung 
out  of  hot  water,  repeated  as  soon  as  it  cools,  often 
affords  relief.  At  times,  however,  hypodermics  of 
morphia  are  needed.  With  the  appearance  of  the 
eruption,  he  finds  that  for  a  few  days  these  mild 
cases  call  for  no  treatment  whatever ;  as  the  symp- 
toms are  greatly  diminished  in  intensity,  and  in 
some  instances  are  altogether  absent. 

In  the  more  severe  attacks,  to  relieve  the  oedema 
of  the  face  and  eyelids  DR.  McCHESNEY  applies 
hot  ivater  compresses  constantly,  changing  them  at 
frequent  intervals.  The  smarting  pain,  generally 
present  over  the  entire  surface  of  the  body,  is 
treated  by  the  application  of  cold  vaseline,  which  is 
much  preferred  by  him  to  the  numerous  ointments, 


222  VARIOLA. 

creams,  etc.  For  the  throat  symptoms,  various 
gargles  are  at  times  employed  ;  e.  g.,  flax-seed  tea, 
solutions  of  potassium  chlorate,  alum,  and  borax. 
In  his  experience,  however,  bromo-chloralum  has 
given  the  greatest  satisfaction,  usually  affording 
quicker  and  more  lasting  relief.  Small  pieces  of 
cracked  ice,  held  in  contact  with  the  mucous  mem- 
brane, are  also  very  grateful.  Externally,  he  uses 
hot  moist  applications  with  benefit ;  together  with 
steam  inhalations,  and  spraying  the  throat  with 
astringent  solutions,  which  often  give  much  com- 
fort. For  the  conjunctivitis,  in  most  cases  a  weak 
solution  of  alum  answers  very  well.  When,  how- 
ever, there  is  also  pain  and  photophobia  he  employs 
the  following  very  effectually : 

^.    Atropise  sulph.         .         .  gr.  ii-iii. 

Aquae      .         .         .         .         .  §  i. 

M.    Sig.    To  be  dropped  into  the  eye. 

Where  the  pain  from  distension  of  the  vesicles  on 
the  hands  and  feet  is  intense,  he  finds  that  soaking 
the  part  in  hot  water  for  fifteen  or  twenty  minutes, 
followed  by  puncture  of  the  vesicles  and  escape  of 
their  contents,  affords  most  relief.  In  confluent 
cases,  when  the  bullae  break,  marked  benefit  is 
derived  from  dusting  the  raw  surface  with  a  powder 
of  bismuth  and  zinc  oxide  ;  or  sometimes  lycopodium 
is  used  for  this  purpose. 


VARIOLA.  223 

In  cases  marked  by  the  early  appearance  of  great 
prostration  and  restlessness,  stimulants  are  freely 
administered,  combined  with  nutritious  food.  When 
extensive  suppuration  is  evident,  the  strength  of  the 
patient  is  supported  by  the  early  use  of  stimulants 
resorted  to,  according  to  indications,  and  continued 
until  convalescence  is  fully  established. 

For  an  antipyretic  in  the  stage  of  secondary  fever, 
DR.  McCHESNEY  has  tried  quinine  in  large  and  fre- 
quent doses,  but  with  poor  results  ;  hence,  he  greatly 
prefers  cold,  in  the  form  of  sponging,  or  the  wet 
pack,  and  places  the  utmost  reliance  upon  its  use. 
This,  he  finds,  not  only  controls  the  temperature, 
but  also  the  delirium  and  restlessness.  In  adminis- 
tering it,  he  always  begins  with  water  that  is  slightly 
tepid,  and  continues  using  it  until  the  temperature 
falls  to  about  the  normal.  In  weak  patients,  the 
addition  of  alcohol  to  the  water  is  often  made  with 
advantage.  If  anodynes  are  required,  he  finds  the 
bromides  or  chloral  very  serviceable.  Caution  is 
advised,  however,  in  their  use,  particularly  in  cases 
where  there  is  an  abundant  expectoration  of  viscid 
mucus  ;  as,  during  sleep,  the  accumulated  secretions 
may  pass  into  the  air-passages  in  sufficient  amount 
to  cause  asphyxia.  During  this  stage,  the  diet  is 
made  of  the  most  nutritious  character,  consisting  of 
milk,  beef-tea,  broths,  eggs,  etc.  Stimulants  are 


224  VARIOLA. 

also  given,  alone,  or  in  the  form  of  milk  punch  and 
the  like. 

When  the  pustules  rupture,  to  relieve  the  burning 
and  itching  of  the  skin,  he  finds  carbolized  baths 
most  effectual,  followed  by  the  free  use  of  vaseline. 
To  correct  the  offensive  odor,  he  much  prefers  a 
solution  of  potassium  permanganate,  or  bromo-chlo- 
ralum,  to  carbolic  acid.  Occurring  in  the  hot  weather, 
he  advises  that  great  care  be  taken  in  preventing  the 
flies  from  depositing  their  eggs  in  the  pustules,  and 
which,  when  developed,  may  cause  serious  results. 
For  this  purpose  he  finds  the  free  application  of  a 
strong  solution  of  permanganate  of  potassium  the 
best  method,  not  only  of  destroying  them,  but  of 
preventing  their  return. 

During  the  period  of  desquamation,  especially  if 
suppuration  has  been  abundant,  he  administers  tonics, 
iron,  quinine,  and  the  bitters,  combined  with  nutri- 
tious food  and  the  use  of  stimulants.  At  this  time, 
frequent  warm  baths  are  found  very  agreeable,  as 
well  as  assisting  in  the  removal  of  the  crusts.  In 
cases  where  the  scabs  about  the  face  and  nose  are 
unusually  adherent,  and  tend  to  prolong  and  increase 
the  ulceration,  he  directs  that  they  be  softened  with 
hot  water,  or  vaseline,  and  removed.  After  which, 
he  makes  direct  application  to  the  bottom  of  the 
ulcer  of  the  following: 


VARIOLA.  22$ 

ty.    lodoformi         .         .         .  gr.  xxx. 

Bals.  tolutan.  .         .         .  %i. 

M. 

By  this  method,  he  has  obtained  the  most  uniformly 
gratifying  results.     In   regard  to  the  prevention  of 
pitting,    DR.    McCHESNEY   has    tried    every   means 
recommended  by  various  authorities  for  this  object  ; 
but  it  is  his  experience  that  if  the  pustules  are  super- 
ficial, the  pitting  will  be  slight,  while  if  the  true  skin 
is  involved,  this  will  occur  in  spite  of  every  endeavor. 
During  convalescence   the   hygienic  surroundings 
receive  the  most    careful    consideration ;    plenty   of 
fresh  air  is  secured,  at  the  same  time  avoiding  any 
exposure,  from  the  risk  of  pulmonary  complications. 
The  following,  from  BELLEVUE  HOSPITAL,  will  be 
found  very  useful  if  broncho-pneumonia  sets  in  : 
$.    Ammon.  carb.         .         .'        .         .      3ss. 
Syr.  senegae  .         .         .  3  iv. 

Syr.  ipecac.  .         .         .        .      3  ii- 

Syr.  tolutan.  .         .         .  3iv. 

Ext.  glycyrrh 3  ss. 

Aq.  cinnam.  q.  s.  ad       .         .  §  iv. 

M.    Dose  :  A  teaspoonful. 

DR.  ALONZO  CLARK  directs  that  the  patient  be 

placed  in  a  large,  well-ventilated  room  provided  with 

an  open   fire  place,  and   from  which   the  carpets  and 

all   unnecessary  furniture  should  be  removed.     The 

15 


226  VARIOLA. 

strictest  attention  should  also  be  given  to  disinfec- 
tion. His  medicinal  treatment  is  in  the  main  symp- 
tomatic. He  advises  that  in  very  many  cases  of 
small-pox,  where  the  tendency  is  to  recover,  but 
little  treatment  is  necessary.  If  there  is  much  ex- 
haustion, he  administers  stimulants  as  in  typhoid 
fever.  Where  a  wide  erysipelatous  inflammation  is 
present,  he  directs  the  room  be  kept  cool,  so  that  the 
coldness  of  the  air  may  modify  the  action  of  the 
inflammatory  disease.  Should  the  patient  exhibit 
great  restlessness,  opium  is  given  in  some  form,  to 
afford  quiet.  If  oedema  glottidis  occurs,  scarification 
is  resorted  to. 

Regarding  the  subsequent  cicatrization,  he  finds 
that  if  early  in  the  disease  the  vessels  be  pricked 
with  a  lancet,  and  kept  empty,  such  a  condition  may 
sometimes  be  avoided.  Or,  the  application  of  the 
old  mercurial  plaster  to  the  face,  he  occasionally  uses 
with  more  or  less  success  in  preventing  the  pitting. 
Another  method  recommended  by  DR.  CLARK,  is  by 
the  use  of  a  mixture  of  collodion  and  animal  black, 
applied  with  a  brush  over  the  face. 

The  following  is  the  formula  used  at  the  Chil- 
dren's Hospital,  Paris,  applied  in  the  form  of  a  plaster, 
and  is  considered  to  be  quite  successful  to  prevent 
the  pitting : 

~fy.     Ung.  hydrarg.    '   .        .        .       part.  xxv. 


VARIOLA.  227 

Cerae  flavae         ....      part.  x. 

M.    Pieis  nig part.  vi. 

In  the  early  stage  of  the  disease,  DR.  A.  L. 
LOOMIS  directs  his  treatment  mainly  to  the  attend- 
ant symptoms.  If  the  thermometer  shows  any 
marked  degree  of  fever,  he  controls  it  by  the  use  of 
cold,  in  the  form  of  the  bath  or  pack  ;  or  by  the  ad- 
ministration of  quinine  in  large  doses.  When  there 
is  much  vomiting,  iced  carbonic  acid  water  is  given 
with  good  effect ;  or  if  with  this  symptom  there  is 
associated  considerable  restlessness,  opium'  is  resorted 
to.  Where  constipation  is  present,  cold  water  ene- 
mata  are  found  very  serviceable,  as  well  as  having 
a  cooling  effect  on  the  blood.  For  the  headache, 
when  severe,  cold  in  the  shape  of  ice-bags,  or  com- 
presses, is  applied  with  benefit. 

With  the  appearance  of  the  eruption,  the  means 
resorted  to  by  him  depend  upon  the  character  of  this 
stage.  Mild  cases  of  discrete  form,  he  finds,  call  for 
little  or  nothing  in  the  way  of  treatment.  Should, 
however,  the  eruption  be  slow  in  development,  or 
late,  with  high  temperature,  he  finds  that  a  warm 
bath  for  a  quarter  of  an  hour  or  longer  often  hastens 
its  development.  When  desiccation  is  reached  he  di- 
rects that  warm  baths,  followed  by  oiling  of  the  body, 
should  be  administered  every  one  or  two  days.  In 
the  severer  forms,  where  there  is  great  depression. 


228  INTERMITTENT  FEVER. 

delirium,  the  typhoid  state,  etc.,  and  especially  dur- 
ing the  suppurative  stage,  stimulants  are  freely  ad- 
ministered and  often  with  the  most  gratifying  effect. 
Where  the  delirium  is  very  marked,  opium  is  also 
given  in  combination. 

In  regard  to  the  pitting,  DR.  LOOMIS  has  tried 
a  number  of  methods  to  prevent  its  occurrence,  but 
finds  that  the  best  results  obtain  from  opening  the 
vesicle  before  it  becomes  a  pustule,  and  dressing  the 
part  simply  with  cold  water. 

DR.  W.  H.  THOMSON  recommends  the  following 
as  a  very  excellent  tonic  formula,  when  indicated  : 
Ipt.     Ferri  et  ammon.  cit.       .  .         3  i. 

Ammon.  carb.         .  .     gr.  xxx. 

Tinct.  gentian,  co. 
Tinct.  quassiae          .         .         .       aa  §  ii. 

Syrupi §  iss. 

Aquae  q.  s.  ad          .          .          .          5  vm'« 
M.     Sig.     One  to  two  teaspoonfuls. 


INTERMITTENT  FEVER. 


DR.  AUSTIN  FLINT  gives  quinine  at  any  stage  of 
the  disease,  until  slight  signs  of  cinchonism  are  de- 


INTERMITTENT  FEVER.  229 

tected.     He  advises  beginning  with  small  doses,  to 
ascertain  the  tolerance  for  the  drug  ;  usually  thus  : 

IJ.     Quiniae  sulph.        .         .         ,        gr.  i-iii. 
Sig.     Dose,  every  four  hours. 

Having  discovered  this,  he  continues  the  adminis- 
tration in  full  doses  until  the  paroxysm  no  longer  oc- 
curs, and  in  smaller  doses  for  a  long  time  afterward. 
He  generally  gives  it  by  the  mouth,  or,  in  other 
cases,  by  the  rectum  in  double  the  quantity  by  means 
of  enemata.  Iron  is  also  employed  for  the  anaemia 
attending  the  disease.  For  the  enlarged  spleen,  he 
finds  that  nothing  so  speedily  diminishes  the  size  as 
quinia. 

DR.  ALONZO  CLARK  considers  the  following  com- 
bination a  most  excellent  one,  and  of  peculiar  value 
in  many  cases : 

ip.     Quiniae  sulph.          ...          gr.  xx. 
Pulv.  capsici      .         .        .  gr.  vi. 

Pulv.  opii      .         .         ...        gr.  i. 

M. 

This  he  has  given  in  very  obstinate  cases  of  long 
standing,  where  the  spleen  has  been  much  enlarged, 
and  with  marked  benefit.  Iq  all  cases,  however,  he 
administers  quinine  daily  for  some  time,  whether 
signs  of  intermittent  fever  present  themselves  or  not. 
Where  cachexia  is  also  more  or  less  prominent,  he 
administers  iron,  usually  in  form  of  the  carbonate 


230  INTERMITTENT  FEVER. 

with  much  satisfaction.  For  this  purpose  the 
chocolate  iron  lozenges,  which  contain  fcrri protocar- 
bon.gr.  iiss.,  are  greatly  preferred  by  him.  The  ad- 
vantage of  this  form  of  iron  preparation,  he  advises, 
is  that  the  chocolate  renders  the  iron  quite  tasteless, 
and  very  agreeable  to  take. 

DR.  F.  A.  BURRALL  directs  attention  to  a  condi- 
tion occurring  in  children  of  from  one  to  two  years, 
sometimes  older,  which  he  finds  is  not  infrequently 
mistaken  for  malaria,  but  which  is  regarded  by  him 
•  as  acute  blood  poisoning  due  to  defective  hepatic 
secretion.  [In  the  milder  forms,  he  advises,  the 
child  suddenly  or  gradually,  while  in  usual  health, 
becomes  indisposed,  pale  or  perhaps  faintly  yellowish, 
has  a  dry  and  somewhat  warmer  skin  than  natural, 
and  an  irritable  stomach  with  constipation,  or  scanty 
light-colored  stools.  If  this  condition  is  not  arrested 
it  tends  to  further  development,  when  the  surface 
becomes  decidedly  yellow  and  dry,  the  pulse  frequent 
and  the  temperature  elevated,  with  headache  more 
or  less  severe,  grating  of  the  teeth,  and  perhaps 
delirium.  The  appetite  is  sometimes  voracious, 
sometimes  lost.  The^  irritability  of  the  stomach 
varies  from  nausea  to  persistent,  and  occasionally 
apparently  uncontrollable,  vomiting.  Repeated 
chills  usually  occur,  and  in  some  cases  sore  throat  is 
present.]  In  these  attacks,  his  indication  for  treat- 


INTERMITTENT  FEVER.  23! 

ment  is  to  promote  the  excretions.     To  accomplish 
this,  he  gives : 

$.    Hydrarg.  chlor.  mit.          .         .      gr.  |-£. 

Sig.  Dose,  every  hour,  placed   dry  upon  the 
tongue. 

The  administration  is  then  repeated  until  four  or 
five  doses  have  been  taken,  or  the  bowels  begin  to 
act.  This  plan,  he  finds,  is  usually  attended  with 
marked  success. 

DR.  J.  C.  PETERS  has  also  met  with  a  number  of 
cases  of  supposed  malaria,  of  the  class  described  by 
DR.  BURRALL  and  has  likewise  obtained  good 
results  from  the  use  of  calomel.  In  .his  experience, 
however,  other  remedies  answer  an  equally  good, 
and  perhaps  better,  purpose.  The  following  is  his 
favorite  formula  for  these  children  : 

I-fc.    Tinct.  aloes  (U.  S.)        .         .         part.  iv. 
Ext.  glycyrrh.  fl.  .         .  pars  i. 

M.    Sig.  m.  xv-xxx-3  i.  according  to  age. 

In  many  so  called  "  mixed "  cases  of  malaria, 
which  do  not  always  yield  promptly  to  quinine,  he 
finds  that  by  a  combination  with  one  of  these,  the 
quinia  acts  more  favorably  than  when  given  without 
an  adjuvant. 

Certain  cases  of  malaria  occurring  in  older  children, 
have  also  been  noticed  at  the  NEW  YORK  HOSPITAL, 
in  which  vesical  irritability  with  nocturnal  inconti- 


232  INTERMITTENT  FEVER. 

nence  of  urine,  pubic  pain,  etc.,  have  been  present ; 
and  in  some  instances  even  simulating  vesical  calcu- 
lus, from  which,  moreover,  careful  judgment  is  often 
necessary  to  diagnosticate.  In  these  cases,  the 
patient  is  placed  on  the  following  treatment  with 
very  gratifying  results.  Laxative  pills  are  ordered, 
one  to  be  taken  three  or  four  nights  in  succession, 
together  with  quinice  sulph.  gr.  iii-v.  two  or  three 
times  daily.  In  conjunction  with  this,  a  pill  con- 
taining^-/, belladonna;  gr.  •§-  is  also  administered  three 
times  daily. 

In  cases  where  anaemia  is  very  marked,  the  follow- 
ing is  often  found  of  great  benefit : 

Ijfc.    Ferri  et  potass,  tart.  .         .         gr.  v. 

Liq.  potass,  arsenit.  .         .         m.  ii. 

Potass,  bicarbon.  gr.  x. 

Tinct.  nucis  vomicae          .         .          m.  v. 

Aquae  ad  .         .         .         .         .    3  i- 

M.  Sig.  To  be  taken  in  a  wineglass  of  water,  be- 
fore eating. 

During  the  paroxysm,  DR.  A.  L.  LOOMIS  directs 
that  the  patient  be  put  to  bed,  and,  in  the  cold  stage, 
well  covered  with  blankets,  bottles  of  hot  water  ap- 
plied to  the  surface  of  the  body,  and  hot  drinks 
freely  supplied.  As  the  hot  stage  comes  on,  these 
are  gradually  removed,  and  cold  drinks  administered. 
The  nausea  and  vomiting  he  usually  relieves  by 


INTERMITTENT  FEVER.  233 

means  of  opium.  In  the  sweating  stage,  no  treat- 
ment is  called  for.  During  the  interval,  he  gives  a 
moderately  large  dose  of  quinine  at  the  close  of  the 
third  stage,  and  double  the  quantity  two  hours  before 
the  occurrence  of  the  next  paroxysm.  Where  the 
stomach  is  too  irritable  the  hypodermic  method  is 
used  ;  for  this  purpose,  the  following  combination  is 
greatly  preferred  by  him  : 

]ji.    Quinias  sulphat.    .         .         .  3i- 

Acid,  hydrobrom.          .         .         .        3  ii. 
Aquae  distill 3  vi. 

M. 

In  very  nervous  cases  he  often  gives  opium  in 
combination  with  good  effect.  A  mild  state  of 
cinchonism  is  then  kept  up  for  several  days ;  after 
which  he  directs  that  the  patient  should  be  seen  one 
month  after  the  first  paroxysm,  as  the  chills  are  very 
liable  to  return  at  this  period,  and  cinchonism  should 
be  again  produced.  When  quinia  alone  fails,  because 
of  an  hyperaemic  condition  of  the  liver  and  spleen, 
he  finds  that  calomel  in  full  doses,  combined  with 
the  former  remedy,  will  often  prove  of  greatest  effi- 
cacy. Arsenic  he  considers  of  little  or  no  service. 

In  those  cases  where  the  infection  has  assumed  a 
chronic  form,  DR.  LOOMIS  advises  that  the  patient 
be  removed  to  a  warm,  dry,  non-malarial  region,  and 
all  exposure  carefully  avoided.  Tonics  he  finds  very 


234  INTERMITTENT  FEVER. 

useful.  Iron  is  given  with  the  quinine,  and  often 
proves  exceedingly  serviceable  when  anaemia  is 
prominent.  Where  the  liver  and  spleen  show  much 
enlargement,  he  considers  the  iodide  of  iron  in  com- 
bination with  cod  liver  oil  particularly  valuable.  He 
also  advises  that  the  bowels  receive  careful  atten- 
tion, and  constipation,  when  present,  relieved  by 
rhubarb  or  aloes.  Arsenic  is  often  found  of  benefit, 
especially  in  cases  where  the  above  means  have 
failed.  The  administration  of  the  drug,  he  advises, 
must  be  watched  with  great  care,  and  immediately 
stopped  on  the  appearance  of  any  constitutional 
effects.  Hygienic  and  dietetic  regulations  also 
receive  proper  care.  A  nutritious  diet  is  con- 
sidered by  him  to  be  of  the  highest  importance,  in 
these  cases. 

At  BELLEVUE  HOSPITAL  the  following  means  are 
often  employed,  in  cases  of  older  children,  to  pre- 
vent the  chill  of  malaria.  In  a  large  number  of 
instances,  chloroform  and  whiskey  are  often  found 
very  efficacious  ;  given  thus : 

IJ.     Spts.  chloroformi 

Spts.  frumenti    .         .         .          aa3  i-ii. 

M.    Sig.  Dose. 

Or,  the  following  is  administered,  and  not  in- 
frequently entirely  prevents  the  occurrence  of  the 
chill : 


TYPHUS   FEVER.  235 

$.    Amyli  nitriti          .  .      gtt.  iii-iv. 

Sig.  To  be  inhaled  every  half-hour,  from  a 
cloth  or  sponge. 

In  other  cases,  pilocarpine  in  doses  of  gr.  -fz-% 
hypodermically  is  often  of  excellent  service.  For  the 
administration  of  quinine  by  hypodermic  injection, 
the  following  formula  is  very  generally  employed  at 
this  hospital : 

$.    Quiniae  sulphat.     .         .  gr.  Ixxx. 

Aquae    .....  §  i.- 

Acid,  sulphuric,  dil.      .         .  q.  s. 

Heat  to  boiling  et  add. 
Acid,  carbol.          .  gr.  v. 

M. 


TYPHUS  FEVER. 


DR.  AUSTIN  FLINT  places  the  patient  on  a  diet  of 
milk,  eggs,  broths,  etc.,  advising,  moreover,  that 
these  should  not  be  given  at  too  short  intervals. 
The  system  is  also  supported  by  stimulation,  par- 
ticularly where  any  undue  depression  is  present. 
Or,  if  there  is  any  doubt  as  to  the  advisability  of  its 
administration,  he  directs  that  the  alcohol  be  given 


236  TYPHUS   FEVER. 

and  its  effects  closely  watched.  Brandy  is  usually 
preferred  by  him,  in  small  doses  at  intervals  of  one 
or  two  hours,  thus  determining  the  amount  required 
daily ;  in  all  cases,  however,  its  toxical  effect  should 
be  carefully  avoided. 

For  the  high  temperature,  he  places  greatest  reli- 
ance upon  cold  as  an  antipyretic,  although  in  some 
instances  quinine  in  large  doses  is  found  very  ser- 
viceable ;  or,  at  times,  aconite  or  veratrum  viride  is 
used.  In  the  application  of  cold  he  considers  the 
wet  sheet  the  best  method  for  continued  use. 
Where  the  bath  is  employed,  if  it  gives  rise  to  no 
unpleasant  symptoms,  he  directs  that  it  be  con- 
tinued until  the  temperature  is  reduced ;  always 
bearing  in  mind  that  a  fall  of  one  degree  or  more 
may  be  expected  after  removal  from  the  bath. 
When  the  temperature  again  rises  above  103°,  the 
process  is  repeated.  Regarding  this  plan  of  treat- 
ment, he  finds  that  unless  it  be  systematically  car- 
ried out,  its  merits  cannot  be  fairly  judged.  The 
sponge  bath  is  also  used  very  effectually,  besides 
affording  comfort  to  the  patient. 

For  the  headache,  cold,  by  means  of  the  douche 
or  the  wet  napkin,  applied  to  the  head  after  having 
cut  the  hair  close,  is  found  of  marked  benefit.  This 
is  also  of  service  in  quieting  the  delirium,  when 
active,  combined  with  the  internal  use  of  opium, 


TYPHUS   FEVER.  237 

either  alone  or  with  small  doses  of  tartar  emetic. 
Where  the  delirium  is  mild  in  character,  no  especial 
treatment  is  required.  If  insomnia  is  a  prominent 
symptom,  this  he  controls  by  the  use  of  the  bro- 
mides ;  or  sometimes  opium  is  necessary. 

To  relieve  the  nausea  and  vomiting,  DR.  FLINT 
advises  that  the  greatest  care  be  exercised  in  the  ad- 
ministration of  the  food,  as  he  frequently  finds  this 
symptom  due  entirely  to  improper  management  of 
the  diet.  In  other  instances  bismuth  and  opium 
powders  are  given  with  good  effect.  This  also 
serves  to  control  the  diarrhoea,  if  present.  The  fol- 
lowing is  used  at  BELLEVUE  HOSPITAL  : 

9.    Bismuthi  subnit.          .         .  gr.  iv. 

Pulv.  ipecac,  co.          ...        gr.  i. 

M.    Sig.    Dose. 

Where,  however,  there  is  diarrhoea  of  a  mild  form, 
it  may  be  let  alone  ;  in  his  opinion,  more  than  three 
or  four  passages  daily  would  indicate  the  resort  to 
measures  for  suppressing  it,  when  astringents,  tur- 
pentine, etc.,  may  be  needed.  For  the  constipation 
which  is  usually  present,  enemata  are  employed. 

In  addition  to  these  means  of  treatment,  the  ob- 
servance of  good  hygiene,  cleanliness,  plenty  of  fresh 
air,  etc.,  receive  the  most  careful  attention. 

The  following  is  often  found  to  be  an  exceedingly 
serviceable  prescription  in  the  condition  of  insomnia 


238  TYPHUS   FEVER. 

and  delirium,  and  is  highly  recommended  by  several 
authorities  who  claim  for  it  magical  effects,  the 
patient  waking  refreshed  and  rational : 

Tfr.    Liq.  opii  sed.  (Battley)         .         .  3  i. 

Antimon.  et  potass,  tart.     .         .         gr.  i. 
Aquae  camphorae         .         .         .          3  vi. 

M.  Sig.  A  dessertspoonful  every  hour,  until 
sleep  is  induced. 

Regarding  prophylaxis  in  the  treatment  of  this 
disease,  DR.  A.  L.  LOOMIS  advises  the  strictest  regu- 
lations of  quarantine,  disinfection,  ventilation,  and 
careful  attention  to  cleanliness,  etc.  He  directs  that 
the  patient  be  placed,  if  possible,  in  a  large,  airy 
room,  free  of  all  materials  likely  to  retain  infection, 
and  an  abundance  of  fresh  air  secured  at  all  times  ; 
this  he  considers  a  factor  of  the  greatest  importance, 
and  believes  that  mild  cases  require  very  little  else 
in  the  way  of  treatment.  The  diet  also  requires  the 
most  careful  attention,  as  regards  the  selection  of 
proper  food,  its  administration,  and  the  avoidance 
of  all  over-feeding.  Force  may  even  be  necessary 
for  the  sustenance  of  the  patient ;  or  the  stomach 
tube  passed  through  the  nares,  is  often  of  great 
service  for  this  purpose.  Milk  he  considers  the  best 
food  for  these  patients,  given  frequently  and  at 
regular  intervals  ;  or  milk  with  yolk  of  eggs  may  be 
used  when  desired. 


TYPHUS  FEVER.  239 

For  the  reduction  of  the  temperature,  he  places 
most  reliance  upon  quinine,  as  a  rule,  although  the 
cold  bath  is  often  used,  particularly  in  the  earlier 
stages  of  the  disease  where  the  exacerbations  are 
more  rapid.  If  necessary  this  is  also  assisted  by  a 
full  dose  of  quinine,  administered  about  twenty 
minutes  after  removal  from  the  bath.  Ice-bags  to  the 
head  are  found  a  serviceable  adjunct  to  the  bath, 
especially  where  there  is  much  pain  in  the  head,  or 
if  active  delirium  is  present  during  its  administration. 
After  the  first  week,  however,  he  usually  finds  that 
quinine  alone  is  a  sufficient  antipyretic,  particularly  if 
the  fever  has  previously  been  kept  below  103°. 

Regarding  the  use  of  alcoholic  stimulants,  DR. 
LOOMIS  does  not  favor  them  in  all  cases,  and  es- 
pecially in  young  subjects.  To  control  the  pulse, 
however,  and  support  the  heart's  action,  stimulants 
are  given  as  indicated  and  with  much  benefit.  Where 
prostration  is  extreme,  the  judicious  use  of  alcohol 
is,  in  many  instances,  followed  by  very  satisfactory 
results.  In  other  cases,  where  frequency  of  the 
pulse,  occurring  in  the  early  stage  of  the  disease,  is 
due  to  a  failing  heart,  digitalis  is  given  and  often 
with  excellent  effect  ;  as  follows  : 

Ijfc.     Infus.  digitalis         .         .         .         3  ii-iv. 
Sig.  This  amount  in  twenty-four  hours. 

For  the  intense  pains  in  the  head,  cold  in   the 


240  TYPHUS   FEVER. 

shape  of  ice-bags  renders  marked  service ;  or  when 
associated  with  photophobia,  a  small  blister  applied 
to  the  back  of  the  neck,  is  found  very  efficacious-. 
The  insomnia  which  is  frequently  present  is  also 
usually  relieved  by  the  use  of  cold  applied  to  the 
head  ;  if  it  persists,  however,  in  spite  of  this  measure, 
opium  is  given  to  control  it.  When  other  marked 
nervous  phenomena  are  also  present,  he  finds  the 
careful  administration  of  chloral  hydrate  very  bene- 
ficial. If  stupor  is  marked,  this  is  met  by  the  local 
resort  to  stimulating  applications,  combined  with  the 
internal  use  of  the  diffusible  stimulants  ;  of  which  he 
prefers  musk  and  camphor,  or  in  some  instances 
coffee. 

During  convalescence,  DR.  LOOMIS  advises  great 
care  in  avoiding  all  over  exertion,  exposure,  etc. 
The  appetite  must  also  be  held  within  bounds.  At 
this  time,  tonics,  iron  and  quinine,  and  the  mineral 
acids  are  often  of  service,  especially  if  there  is  feeble 
heart  action.  For  this  purpose,  the  following,  one 
of  Dr.  Loomis'  favorite  tonic  formulas,  may  be  found 
of  marked  benefit : 

9.    Sol.  quiniae  sulph.  (gr.  xv- §  i.)      •        3  »• 
Tinct.  ferri  chlor.  .         .  5SS- 

Spts.  chloroformi  .         .         .      3vi. 

Glycerinae  q.  s.  ad          .         .  §  iv. 

M. 


i  >TITIS.  241 

OTITIS. 

(EAR-ACHE.) 


For  the  pain,  which  DR.  O.  D.  POMEROY  believes 
should  receive  primary  consideration,  he  finds  the  ap- 
plication of  one  or  two  leeches  to  the  part,  the  best 
plan  of  treatment.  If,  as  occasionally  happens,  the 
leech  aggravates  the  pain,  morphia  is  cautiously 
used,  which  acts  as  a  true  anti-phlogistic  as  well  as 
anodyne.  He  then  repeats  the  bleeding,  if  necessary, 
so  long  as  the  pain  or  sensation  of  fullness  con- 
tinues ;  care  being  taken,  however,  not  to  produce 
exhaustion.  In  many  cases,  he  advises,  milder 
measures  suffice  ;  such  as  the  application  of  dry  heat, 
by  means  of  a  rubber  bag,  or  a  bottle,  of  hot  water, 
the  temperature  being  adjusted  to  the  comfort  of  the 
patient.  Water  either  too  hot  or  too  cold,  he  finds, 
will  only  serve  to  increase  the  pain.  Hot  salt  bags 
are  also  used  very  effectually,  or  sometimes  a  roasted 
onion  acts  well.  Regarding  moist  applications,  in 
his  experience  although  they  afford  relief,  yet,  if 
continued  too  long,  otorrhoea  and  other  serious  re- 
sults may  follow.  A  little  paregoric  on  cotton  is 
also  serviceable,  or  at  times  morphia  is  cautiously 
employed.  In  other  cases,  he  finds  that  a  bit  of  cot- 
16 


242  OTITIS. 

ton  with  black  pepper  wrapped  in  it,  will  warm  the 
parts  and  allay  the  pain.  (This  should  first  be  tried 
on  an  adult,  so  as  to  avoid  excessive  burning.)  The 
following  is  also  regarded  by  him  as  very  efficacious : 

Jjfc.     Atropiae  sulph.         .         .          .         gr.  iv. 
Aquae §  i. 

M.     Sig.     To  be  dropped  into  the  eye. 

Steam,  or  the  vapor  of  chloroform,  blowrn  into  the 
ear,  are  also  employed  with  good  result. 

Regarding  puncturing  of  the  membrane,  if  there  is 
a  collection  of  the  secretions  in  the  tympanum,  DR. 
POMEROY  considers  this  operation  more  appropriate 
for  the  relief  of  pain,  than  leeching.  Where  no  dis- 
charge follows  the  puncture,  he  then  resorts  to  in- 
flation ;  and  by  inclining  the  head  to  the  affected  side, 
all  the  discharge  may  in  this  way  be  blown  out.  This 
is  repeated  every  day  or  two  until  the  accumulation 
has  finally  ceased.  After  the  pain  is  relieved,  he  di- 
rects that  cotton  be  kept  in  the  ear,  removing  it  as 
often  as  it  becomes  moistened.  The  ear  is  also 
kept  clean  by  injections  and  syringing,  very  gently 
(so  as  not  to  cause  a  return  of  the  throbbing 
pain),  writh  a  warm  saline  solution  (3  i-Oi.),  and  care- 
fully wiped  out  and  dried  once  or  twice  daily. 
After  two  or  three  days  he  inflates  the  drum,  and 
if  the  discharge  does  not  diminish  in  from  four  to 
six  days,  he  then  resorts  to  astringents.  For  this 


OTITIS.  243 

purpose     the     following     is     often     preferred     by 
him : 

]pL     Plumbi  acetat.  gr.  ii-v. 

Aquae         .....  §  i. 

M.  To  be  poured  into  the  ear  twice  daily,  after 
syringing. 

Or,  sometimes  argenti  nitrat.  of  the  same  strength 
is  used.  If  a  disinfectant  is  needed,  the  following 
may  be  employed  instead  of  the  above : 

I£.     Acidi  carbolici         .         .         .  3  i. 

Aquae §xvi. 

M. . 

But,  in  any  case,  he  advises  that  whatever  astrin- 
gent be  used,  none  should  cause  excessive'  pain  or 
make  the  ear  throb  afterward. 

This  plan  of  treatment  DR.  POMEROY  usually  finds 
quite  successful.  Where,  however,  the  discharge 
does  not  disappear,  he  then  fills  the  canal  with  boracic 
acid,  finely  powdered,  well  packed  in  by  means  of 
cotton  (using  a  holder),  and  permits  it  to  re- 
main until  it  becomes  moistened  by  the  dis- 
charge, when  it  is  removed  by  syringing  and  again 
renewed. 

DR.  A.  JACOBI  finds  that  in  many  severe  forms  of 
ear-ache,  where  the  trouble  is  probably  caused  by  a 
catarrhal  affection  of  the  Eustachian  tube,  by  closing 
the  mouths  of  infants  and  children  and  simply  blow- 


244  OTITIS. 

ing  into  the  nose,  is  often  a  very  valuable  method  of 
affording  relief  to  the  pain. 

DR.  R.  F.  WEIR  uses  morphine  and  atropine  very 
effectually  to  control  the  pain,  together  with  injec- 
tions of  hot  water,  that  is  to  say,  by  pouring  the 
water  into  the  ear,  not  syringing  it ;  and  in  many 
instances  this  latter  measure  alone  suffices,  the  child 
falling  asleep  during  the  procedure.  Leeches  he 
objects  to.  Regarding  paracentesis,  he  finds  that 
especially  in  children  the  external  canal  is  often 
swollen  and  painful,  thus  rendering  the  operation 
difficult  and  impracticable ;  hence,  he  advises  that, 
as  a  rule,  it  is  best  to  let  the  drum  alone. 

DR.  A.  A.  SMITH  is  in  the  habit  of  using  warm 
douches,  together  with  the  application  of  heat  in  the 
form  of  hot  salt  bags.  In  some  cases,  however,  he 
finds  it  necessary  to  give  a  full  dose  of  an  anodyne. 
He  has  also  obtained  good  results  from  blowing 
chloroform  vapor  into  the  ear. 

DR.  BEVERLY  ROBINSON  has  derived  benefit  from 
the  application  of  leeches,  when  all  other  means  had 
failed.  He  also  finds  much  relief  afforded  by  the 
use  of  the  continuous  douche.  In  other  instances, 
he  has  used  salicylate  of  soda  in  large  doses  very 
successfully  in  allaying  the  pain. 

DR.  C.  R.  AGNEW  considers  the  warm  douche  and 
opium  of  the  greatest  value. 


OTITIS.  245 

In  all  cases,  DR.  S.  SEXTON  regards  rest  and  quiet 
as  very  important  in  the  treatment,  confining  the 
child  to  the  house  for  several  days,  and  if  the  case  is 
a  severe  one,  in  bed.  All  active  measures,  he  ad- 
vises, should  be  avoided,  particularly  inflation,  and 
the  patient  cautioned  against  violently  blowing  the 
nose.  For  the  immediate  relief  of  pain,  where  the 
condition  of  the  canal  admits  of  deep  applications 
being  made,  belladonna  is  found  very  serviceable. 
For  this  purpose,  he  paints  the  deeper  parts  over 
with  a  small  quantity  of  the  following: 

Ijfc.    Ung.  belladon. 

Olei-paraffini  (Vaseline)    .         .       aa  ^  i. 

M. 

Or,  sometimes  the  following  is  preferred : 

]jfc.    Atropiae  sulphat.  gr.  v. 

Aquae         .         .         .         .         .  ^  i. 

M.    Sig.  Four  drops,  to  be  dropped  in  the  ear. 

In  using  these,  he  advises  that  they  should  be  first 
warmed,  and  the  canal  previously  freed  of  secretions. 
Dry  warmth,  when  grateful,  is  also  applied  with 
much  benefit ;  either  as  heated  air  from  hot  salt 
bags,  or  by  means  of  heated  pillows.  In  some  in- 
stances this  may  be  all  that  is  required.  He  also 
finds  that  this  measure  accomplishes  just  as  much  as 
warm  water,  which,  though  often  beneficial  when 
poured  directly  upon  the  drum  head,  may  prove  in- 


246  OTITIS. 

jurious.  Or,  at  times,  gentle  fomentations  or  steam- 
ing is  employed,  but  all  active  syringing,  douching, 
poulticing  and  the  like,  are  particularly  objected  to  ; 
indeed,  he  believes  these  measures  often  do  positive 
harm.  In  the  later  stages,  however,  syringing  and 
mopping  is  more  thoroughly  practiced,  and  occasion- 
ally the  air  douche  is  cautiously  employed.  Ano- 
dynes are  seldom  used  by  him  with  children  ;  more- 
over, he  finds  that  large  doses  of  narcotics  only 
serve,  sooner  or  later,  to  make  the  trouble  worse. 

In  regard  to  puncturing  the  membrane  when  no 
discharge  occurs  from  the  inflamed  parts,  DR.  SEX- 
TON advises  that  a  resort  to  this  procedure  should 
receive  the  most  careful  judgment.  In  his  experi- 
ence it  is  not  always  demanded  for  relief,  even 
where  the  membrana  tympani  is  much  protruded  by 
the  accumulated  secretions ;  as  he  finds  other  means 
of  treatment  often  efficient  in  causing  the  pain  and 
inflammatory  symptoms  to  speedily  subside.  When, 
however,  there  is  considerable  thickening  and  tough- 
ening from  previous  attacks,  attended  with  closure 
of  the  Eustachian  tube,  he  considers  the  operation 
justifiable ;  and,  when  indicated,  he  directs  that  it  be 
done  promptly,  under  the  influence  of  an  anaes- 
thetic. 

The  use  of  leeches  he  finds  unsatisfactory,  as  the 
abstraction  of  blood  from  the  adjacent  part  of  the 


OTITIS.  247 

cheek,  or  even  from  the  concha,  does  not  relieve 
the  deeper  congestion.  Moreover,  besides  the  irri- 
tation from  the  bite,  their  appearance  tends  to 
frighten  the  child,  and  often  it  is  difficult  to  check 
the  bleeding.  Blistering,  and  painting  with  iodine, 
he  regards  as  too  irritating  in  effect,  and  should  be 
avoided. 

In  cases  of  ear-ache  associated  with  nervous  ex- 
citement, he  places  most  reliance  upon  pulsatilla, 
especially  in  very  young  children,  giving  it  thus: 

$-    Tinct.  anemon.  praten.         .         gtt.  v-x. 
Aquae    .....  ^  iv-vi. 

M.    Sig.    A  teaspoonful  as  necessary. 

He  also  uses  aconite  and  gelsemium  with  great  ef- 
ficacy. In  either  case,  he  advises  the  importance  of 
obtaining  a  tincture  from  the  fresh  plant. 

Calcium  sulphide  is  considered  by  him  to  be  a 
most  valuable  remedy,  and  he  rarely  finds  that  any 
nausea  is  produced  by  its  use.  In  his  opinion  it 
both  prevents  and  arrests  suppuration,  or  it  may 
limit  the  inflammation  and  hasten  recovery.  In  these 
cases  he  usually  gives  the  drug  in  pill  form,  but 
where  this  is  impracticable,  it  may  be  administered 
in  the  form  of  a  trituration  ;  thus: 

p.    Calcii  sulphidi  gr.  \. 

Sacchari  lactis  .         .         .  gr.  ii-iii. 

M.    Sig.  Dose,  every  three  or  four  hours. 


248  OPHTHALMIA. 

Finally,  in  all  cases  of  ear  affections,  he  particu- 
larly directs  that  an  examination  of  the  mouth  and 
upper  part  of  the  pharynx  should  always  be  made, 
and  any  causes  of  irritation  there  present  receive 
careful  treatment ;  e.  g,  caries  and  other  disorders  of 
the  teeth  and  gums,  naso-pharyngeal  catarrh,  etc. 


OPHTHALMIA. 


In  simple  catarrhal  affections  of  the  eye,  DR.  C. 
R.  AGNEW  advises  that  it  would  be  much  better  if 
the  general  practitioner  should  never  resort  either 
to  the  solid  stick,  or  strong  solutions,  of  silver  nitrate, 
or  the  sulphate  of  copper.  He  also  cautions  against 
the  use  of  poultices,  his  belief,  in  this  respect,  being 
formulated  thus  :  "  If  you  want  to  put  the  eye  out, 
poultice  it."  In  his  experience  the  following  is  the 
most  effectual  treatment  in  these  cases : 

"$.    Acidi  tannici     .         .         .         .         gr,  x. 
Sodii  biborat.  gr.  x. 

Glycerinae          ....  3  i. 

Aquae  camphorae      ...  §  i. 

M.  Sig.  To  be  applied  once  daily,  in  form  of  the 
spray. 


OPHTHALMIA.  249 

For  applying  this,  he  uses  a  Davidson's  atomizer, 
No.  55,  thoroughly  spraying  the  everted  lids  once 
daily.  (After  using  this  solution  in  an  atomizer,  it 
it  will  be  necessary,  each  time,  to  wash  the  instru- 
ment out  with  water,  in  order  to  keep  it  in  perfect 
working  condition.)  In  addition  to  the  spray,  he 
directs  that  the  eyes  be  bathed  with  a  solution  of 
salt  in  water,  3  i-Oi.,  the  temperature  of  the  water  to 
be  determined  by  the  feelings  of  the  patient.  Or, 
in  many  instances,  he  employs  the  following  with 
equally  good  results  : 

1$.    Sodii  biborat 3  »• 

Aquae  camphorae         .         .         .         %vi. 

M. 

Of  this,  a  tablespoonful  is  to  be  mixed  with  a 
tablespoonful  of  hot  water,  and  used  for  bathing  the 
eyelids  from  three  to  five  times  daily.  In  doing  this, 
he  advises  the  precaution  of  freshly  mixing  the  solu- 
tion each  time  it  is  used  ;  otherwise,  some  patients 
are  apt  to  continue  with  the  same  water  over  and 
over  again. 

In  all  cases,  DR.  AGNEW  directs  especial  attention 
to  diet,  hygiene,  and  exercise.  The  prevalent  habit 
of  scant  feeding  must  be  corrected,  and  the  food 
made  of  the  most  nutritious  character,  taken  regularly 
and  in  gradually  increasing  amounts.  These  measures 
he  considers  of  the  highest  practical  importance. 


25O  OPHTHALMIA. 

In  the  purulent  ophthalmia  of  infants,  DR.  J. 
LEWIS  SMITH  recommends  the  following  with  much 
satisfaction : 

1$.    Hydrarg.  corros.  chlor.       .         .        gr.  i. 
Aquae  rosae          .         .         .         .          §  ii. 

Aquae §vi. 

M.    Sig.  Apply  every  three  hours. 


PART   VI. 
SKIN   DISEASES. 


ECZEMA. 


In  infantile  eczema,  DR.  L.  DUNCAN  BULKLEY 
advises  that  too  much  dependence  must  not  be 
placed  on  the  local  treatment  of  the  disease,  as  he 
finds  that  evidences  of  imperfect  assimilation  can  al- 
ways be  discovered  in  these  children.  The  evacua- 
tions from  the  bowels  are  faulty  ;  the  urine  con- 
stantly presents  traces  of  mal-assimilation,  and 
thorough  investigation  invariably  shows  an  imperfect 
state  of  health.  Moreover,  in  nursing  children,  he 
considers  it  of  the  highest  importance  that  careful 
attention  be  paid  to  the  mother,  who  very  frequently 
exhibits  dyspepsia  or  constipation,  or  is  considerably 
debilitated  ;  or  possibly  is  taking  ale,  beer,  unnatural 
quantities  of  tea,  etc. ;  all  of  which  disagree  and 
cause  trouble  in  the  child.  Therefore,  if  the  in- 
fluence of  internal,  general,  dietary,  and  hygienic 

' 


252  ECZEMA. 

causes  be  strictly  attended  to,  he  finds  that  much 
less  in  the  way  of  treatment  is  required  locally ;  and 
what  is  thus  used,  is  more  rapidly  and  more  com- 
pletely successful.  But  he  also  cautions  that  if  these 
are  not  recognized  and  managed  with  care,  the  re- 
sults of  local  treatment  are  imperfect  and  uncertain. 

Internal  medication,  to  a  certain  degree,  he  con- 
siders absolutely  necessary.  As  a  rule,  he  gives 
small  purgative  doses  of  calomel  every  other  day, 
and  a  mild  alkali,  such  as  potassium  acetate  in  the 
liquor  ammoniae  acetatis,  with  a  little  nitre,  and  per- 
haps aconite.  Individual  cases,  however,  require  dif- 
ferent management. 

In  regard  to  mechanical  restraint  to  prevent  the 
scratching,  DR.  BULKLEY  aims  to  relieve  the  itching 
by  proper  applications,  and  thus  avoid  resorting  to 
such  extreme  measures.  The  diachylon  ointment, 
employed  by  some,  he  considers  very  inefficient  for 
this  purpose  in  infantile  cases.  Tar  in  some  form 
is  much  preferred,  the  following  combination  being 
a  favorite  with  him  : 

$.    Unguent,  picis        .         .         .  5  i- 

Zinci  oxidi      .         .         .         .  3  ii. 

Unguent,  aquae  rosse      .         .         .     §  iii. 

M. 

This,  he  advises,  should  be  carefully  prepared,  and 
very  thoroughly  and  abundantly  applied.  If  it  ap- 


ECZEMA.  253 

pears  stimulating,  less  of  the  tar  ointment  is  used. 
He  lays  great  stress  on  employing  the  rose  ointment, 
and  not  simple  cerate,  or  lard,  or  vaseline,  or  pe- 
troleum. He  also  directs  that  the  ointment  be  made 
of  a  consistency  to  spread  easily,  and  yet  not  to  all 
melt  away  after  application.  Concerning  the  use  of 
water  to  eczematous  surfaces  in  children,  he  advises 
that  they  should  be  washed  only  as  directed,  and 
that  very  rarely ;  often  only  at  intervals  of  several 
days.  Furthermore,  in  his  experience,  it  is  all  im- 
portant that  the  protective  ointment  be  replaced 
immediately  after  the  surface  is  dried,  and  renewed 
sufficiently  often  to  keep  the  parts  completely 
shielded  ;  even  twenty  or  more  times  during  the  first 
day.  On  covered  parts,  the  ointment  may  be  spread 
thickly  on  the  wooly  side  of  sheet  lint,  and  bound 
on.  As  to  the  use  of  a  mask  for  the  face,  he  never 
resorts  to  this  measure,  and  rarely  finds  it  necessary 
to  restrain  the  infant  much  after  the  first  day  or 
two.  The  only  approach  to  this  practiced  by  him, 
is  putting  on  muslin  mittens,  tied  about  the  wrist, 
and  with  tapes  from  these  passing  behind  the  back, 
or  beneath  one  leg.  Under  this  management,  if 
every  particular  is  carried  out,  he  is  assured  of  but 
one  result,  namely,  arrest  of  the  eruption  and,  if  the 
dietetic  and  hygienic  elements  are  also  persisted 
in,  a  cure  of  the  disease. 


254  ECZEMA. 

Regarding  arsenic  in  the  treatment  of  eczema, 
although  not  considered  as  a  specific,  yet  he  finds  it 
of  great  service,  on  account  of  its  effect  in  quieting 
nervous  irritation.  Indeed,  in  many  instances,  he 
has  obtained  almost  instant  relief  from  the  internal 
administration  of  Fowler's  solution  alone.  As  a 
rule,  in  all  cases,  he  gives  arsenic  internally  at  some 
stage  of  the  disease. 

In  eczema  of  the  anus  and  genitals,  not  infre- 
quently met  with  in  older  children,  and  more 
particularly  in  chronic  cases,  DR.  BULKLEY  has 
derived  great  satisfaction  from  the  following  method 
of  treatment.  To  correct  the  imperfect  intestinal 
secretions  and  the  imperfect  liver  action,  which  is 
usually  an  accompaniment  of  this  condition,  is,  in  his 
estimation,  of  primary  importance.  For  this  purpose 
he  advises,  the  most  careful  judgment  is  often 
necessary  ;  purgatives  and  laxatives  are  not  sufficient, 
nor  does  any  routine  plan  answer  for  all.  Generally, 
however,  he  finds  the  following  prescription  very 
useful : 

Tfr.    Sulphur,  praecipitat. 

Potass,  bitart.         .         .         .  aa  ^i- 

M.  Sig.  A  teaspoonful  at  night,  rubbed  up  with 
sufficient  water  to  make  a  paste. 

In  addition,  diet,  hygiene,  exercise,  and  regularity 
in  attending  to  the  calls  of  nature,  are  also  required, 


ECZEMA.  255 

together  with  what  internal  medicinal  assistance  may 
be  needed.  If  the  disease  is  simply  due  to  debility, 
he  administers  iron  and  other  tonics  with  niuch 
benefit.  Arsenic  he  seldom,  if  ever,  employs  as  a 
curative  measure  at  the  beginning,  in  these  cases,  and 
especially  not  in  acute  forms.  But  in  the  later  stages, 
and  where  there  is  marked  eczematous  habit,  when, 
after  all  other  means  have  been  carefully  attended  to, 
there  still  remains  a  tendency  to  the  disease,  he  then 
uses  arsenic  in  connection  with  other  remedies. 

Local  treatment  is  also  considered  of  vast  impor- 
tance. He  particularly  cautions,  however,  that  too 
strong  applications  are  apt  to  do  more  harm  than 
good,  and  directs  that  the  soothing  plan  be  followed 
as  far  as  possible,  especially  where  there  are  signs  of 
inflammation  present ;  stimulating  measures  being 
resorted  to  only  in  the  later  stages.  The  itching,  he 
finds,  yields  promptly  to  mild  treatment,  together 
with  the  proper  general  assistance.  He  places  most 
reliance  upon  hot  water  (not  merely  warm)  to  relieve 
the  congestion.  To  be  of  service,  however,  DR. 
BULKLEY  insists  that  the  following  plan  must  be 
strictly  adhered  to.  He  directs  that  the  patient  be 
made  to  sit  upon  the  edge  of  a  chair,  having  a  basin 
of  water  at  hand  with  a  soft  handkerchief  in  it.  This 
latter  is  then  to  be  held  in  a  mass,  as  hot  as  can  be 
borne,  to  the  parts,  for  a  minute  at  a  time,  and  the 


256  ECZEMA. 

process  repeated  three  times.  Too  long  or  too  fre- 
quent bathing,  or  rubbing  with  a  cloth,  is  injurious. 
Ordinarily,  the  hot  water  is  applied  only  once  in 
twenty-four  hours ;  usually  immediately  before  retir- 
ing thus  affording  a  quiet  and  generally  sound  sleep. 
All  scratching,  or  even  touching  the  part,  must  be 
carefully  avoided  if  possible.  Before  applying  the 
hot  water,  the  ointment  to  be  employed  is  prepared, 
•thickly  spread  on  lint,  and  cut  of  a  size  to  cover  the 
affected  parts  only.  After  these  have  been  dried  by 
soft  pressure,  but  absolutely  without  friction,  the 
already  spread  cloths  are  immediately  applied,  thus 
at  once  and  entirely  excluding  the  air.  In  severe 
cases  the  hot  water  is  repeated  occasionally,  but 
usually  he  finds  it  sufficient  to  simply  renew  the 
ointment  one  or  more  times  during  the  day.  The 
ointment  employed  varies  somewhat  with  the  case  ; 
as  a  rule,  however,  he  prescribes  the  tar  and  zinc 
oxide  ointment  with  ung.  aquae  rosae,  already  men- 
tioned. Vaseline,  as  a  base,  is  objected  to,  as  it 
soaks  in  too  rapidly ;  thus  leaving  the  parts  dry  and 
exposed  to  the  air  Or,  in  other  instances,  the  fol- 
lowing combination  is  used  by  him  very  effectually: 
IjL  Unguent,  picis  .  .  .  3  iii- 

Unguent,  bellad.      ...  3  ii- 

Tinct.  aconit.  rad.          .         .  3  ss. 

Zinci    oxidi         .         .         .         •  3  i- 


ECZEMA.  257 

Unguent,  aquae  rosae.         .         .         §  iii. 
M.    Ft.  unguent. 

An  ointment  of  chloral  and  camphor  is  also,  in  his 
experience,  a  very  efficient  anti-pruritic.     This  he 
formulates  as  follows : 
9,.    Chloral,  hydrat. 

Camphorae        ...  aa   3  i-ii. 

Ung.  aq.  rosae      .         .         .         .         §  i. 
M. 

Or,  in  certain  cases,  he   finds  lotions  sometimes 
very  serviceable  ;  often  prescribing  the  following : 
$.    Bismuthi  subnit.           .         .         .          3  ii. 
Acid,  hydrocyan.  dil.  .         .         .  3  i. 

Emuls.  amygd.  .         .         .          §  iv. 

M.    Ft.  lotio. 

This,  he  advises,  should  not  be  used  where  the 
skin  is  torn  or  broken.     When  stronger  applications 
are  necessary,  as  in  cases  where  congestion  has  ceased, 
leaving  some  thickening  and  a  tendency  to  the  forma- 
tion of  fissures,  he  uses  the  following  with  good  effect. 
]pfc.     Saponis  viridis 
Olei  cadini 

Alcohol  .         .         •        .         aa  §  i. 

M. 

This  is  rubbed  briskly  over  the  parts  for  a  few 
minutes,  and  followed  immediately  afterward  by  a 
mild  ointment,  such  as : 
17 


258  ECZEMA. 

IpL     Zinci  oxidi      .          ...  3  ss. 

Ung.  aquae  rosae      ...  %  i. 

M. 
Or: 

IjL     Bismuthi  subnit.         .         .        .         3ss. 
Ung.  aq.  rosae        .        .        .         .      §  i. 

M. 

Or,  he  sometimes  substitutes  calomel  for  either 
the  zinc  or  the  bismuth,  with  much  satisfaction.  Oc- 
casionally,  however,  DR.  BULKLEY  resorts  to  the  ap- 
plication of  caustic  potash  in  solution,  followed  by 
soothing  measures.  When  the  fissures  still  persist, 
the  solid  stick  of  silver  nitrate  is,  at  times,  employed  ; 
after  which  the  part  is  packed  with  cotton.  But 
these  ultimate  means  of  relief,  he  advises,  are  to  be 
used  with  caution,  otherwise  bad  results  may  follow. 

In  the  treatment  of  infantile  eczema,  DR.  A. 
JACOBI  advises  that  the  addition  of  potassium  to 
cow's  milk  is  contraindicated,  since  it  already  con- 
tains too  much  in  comparison  with  the  breast  milk. 
In  his  experience-  sodium  should  be  added,  rather 
than  potassium. 

The  use  of  water  should  also  be  avoided.  In  some 
instances  he  finds  it  necessary  to  employ  physical 
restraint,  to  prevent  the  child  from  scratching.  As 
a  rule,  also,  a  mask  for  the  head  and  face  generally 
proves  very  serviceable.  In  chronic  cases,  the  first 


ECZEMA.  259 

indication  is  removal  of  the  scab.     For  this  purpose, 
he  uses  the  following  mixture  very  effectually : 

"fy.     Liquor  potassae        .  §i. 

Olei  olivae  §  viii-x. 

M.  Sig.  To  be  applied  from  two  to  five  times 
daily. 

Or  cod  liver  oil  is  sometimes  substituted  for  the 
olive  oil.  This  application  soon  breaks  up  the  crusts 
so  that  they  can  easily  be  removed.  In  mild  cases, 
he  often  finds  that  oil,  soap,  or  poultices  will  suffice. 
After  their  removal,  the  surface  is  kept  dry  with  soft 
cloth,  and  a  new  formation  of  scab  thus  prevented. 
An  ointment  is  then  applied,  of  which  DR.  JACOBI 
usually  places  most  reliance  upon  the  nnguentum 
diachylon.  For  constitutional  treatment,  he  admin- 
isters arsenic,  and  iron  when  indicated,  with  marked 
benefit. 

The  following  is  the  formula  for  the  above  oint- 
ment, as  used  at  BELLEVUE  HOSPITAL  : 

$.  Emplast.  plumbi  .  .  .  §v. 
Olei  olivse  .  .  -  .  .  ^  iv. 
Olei  lavandulae  ...  3  i. 

M. 

In  infantile  cases,  if  the  child  is  still  nursing,  DR. 
G.  H.  FOX  directs  that  the  time  of  feeding  be  regu- 
lated so  that  the  breast  is  given  only  at  stated 
periods;  beginning  at  first  with  intervals  of  one  and 


260  ECZEMA. 

one-half  hours,  and  working  up  gradually  until  three 
hours  intervene  between  the  nursings.  In  older 
children,  he  insists  upon  strict  regulation  of  the 
diet,  which  is  usually  in  a  poor  condition,  confining 
the  patient  to  meat,  soups,  milk  with  and  without 
bread,  oatmeal,  eggs,  etc.  ;  and  stopping  all  tea,  cof- 
fee, beer,  spirit,  candy,  cakes,  and  the  like,  either  at 
meals  or  between  them.  Plenty  of  exercise  in  the 
open  air  is  also  advised. 

For  local  treatment,  he  first  loosens  the  crusts  by 
soaking  them  with  olive  oil,  and  after  their  complete 
removal,  he  then  applies  ung.  zinci  oxidi,  by  spread- 
ing it  thickly  upon  old  linen  and  binding  it  upon  the 
part.  In  cases  of  eczema  capitis,  he  sometimes  or- 
ders the  use  of  the  following  with  much  benefit : 

^.     Acidi  boracici         .         .         .         .     3ii. 
Aquae §i. 

M. 

After  washing  the  head  thoroughly  with  the  above 
solution,  unguent,  cadini  Zi-^i.  is  applied.  In 
other  instances,  wrhere  the  discharge  is  very  free  and 
abundant,  matting  the  hair  together  and  forming 
thick  scabs,  after  washing  the  crusts  with  oil  and 
soap,  and  thoroughly  removing  them,  he  generally 
obtains  excellent  results  by  applying  the  following 
ointment : 

Ijfc.    lodoformi          .         .         .         .  3 ii. 


ECZEMA.  26l 

Ung.  zinci  oxidi        ...  j§  "*• 

M. 

Or,  where  the  eruption  covers  a  larger  surface,  as 
the  entire  face  and  occiput,  he  directs  that  a  mask 
of  white  flannel  be  made,  with  holes  for  the  eyes, 
nose,  and  mouth,  and  with  this  to  retain  in  position 
the  cloths  spread  with  ointment.  In  such  cases,  also, 
the  zinc  oxide  ointment  is  often  used  very  success- 
fully. 

For  internal  medication,  he  frequently  prescribes 
the  following  with  good  service : 

]pfc.    Potassii  acetat gr.  v. 

Aquae q.  s. 

M.  Sig.  Dose,  three  times  daily,  to  a  child  of 
one  to  two  years. 

If  the  bowels  are  constipated,  as  is  usually  the 
case  in  infants,  he  administers  calomel  in  doses  of 
gr.  ss.  with  much  benefit. 

In  the  eczema  of  older  children,  even  of  long 
standing,  DR.  Fox  finds  that  as  a  rule,  to  which 
there  are  few  exceptions,  the  disease  responds  readily 
to  appropriate  treatment ;  and  cases  which  have 
been  considered  as  incurable,  he  frequently  finds  the 
easiest  ones  to  cure.  If  seen  in  the  first  stage, 
when  practicable,  he  directs  that  thin  sheet  rubber  be 
applied  to  the  part,  or,  where  this  cannot  be  pro- 
cured, oil-silk.  By  this  means  the  surface  exudation 


262  ECZEMA. 

is  promoted,  and  the  swelling  and  itching  in  a  great 
measure  relieved.  His  next  object,  as  far  as  local 
treatment  is  concerned,  is  to  soothe  and  protect  the 
thin,  tender,  newly-formed  epidermis  (second  stage), 
and  to  prevent  a  recurrence  of  the  swelling,  which 
would  inevitably  restore  the  moist  condition  of  the 
eruption.  This  he  accomplishes  by  the  application, 
night  and  morning,  of  the  ordinary  zinc  oxide  oint- 
ment, spread  on  strips  of  cloth  and  secured  with  a 
muslin  bandage ;  a  rubber  bandage,  he  advises,  which 
proves  decidedly  efficacious  in  the  early  period  of 
the  treatment,  would  now  do  more  harm  than  good. 
In  the  third  stage,  he  applies  the  ointment  of  cade 
locally,  and  administers  potassium  acetate  internally, 
with  excellent  effect ;  or  sometimes  unguent,  dia- 
chyli  is  used  with  best  results.  Or,  where  the  scalp 
is  involved,  he  often  prefers  the  white  precipitate ; 
thus: 

]pL     Hydrarg.  ammoniat.         .         .     part.  iv. 
Thymol  ....         parsi. 

Oleo-paraffini  (vaseline)  .         .     part.  xlv. 

M.    Ft.  ung. 

In  chronic  cases,  often  with  the  dry,  erythematous 
form  of  eczema  present,  where  the  general  health  is 
impaired,  DR.  Fox  advises  that  although  the  local 
means  employed  afford  temporary  relief,  the  erup- 
tion can  only  be  permanently  cured  when  the  health 
of  the  patient  has  been  in  a  marked  degree  restored. 


ECZEMA.  263 

He  therefore  resorts  to  the  use  of  tonics,  alkaline 
diuretics,  etc.,  continued  for  some  time.  In  these 
cases,  also,  instead  of  zinc  oxide  ointment  alone,  he 
frequently  adds  ten  per  cent,  of  cade.  In  chronic 
eczema  of  the  scalp,  he  considers  the  following  very 
desirable  in  many  cases : 

IpL    Olei  cadini §i. 

Olei  amygd.  dulc.     .        .  §  in. 

M. 

The  effect  of  local  treatment,  however,  is  apt  to 
be  very  uncertain. 

DR.  W.  H.  DRAPER  considers  rest  very  important, 
especially  where  the  itching  is  intolerable ;  as  the 
child  is  thus  deprived  of  sleep  at  night,  and  the 
constitution  becomes  run  down,  preventing  success- 
ful treatment.  Therefore,  by  paying  attention  to 
this  particular,  he  finds  that  surprisingly  good  results 
often  obtain  in  a  very  short  period.  In  these  cases, 
as  a  rule,  he  places  the  child  at  once  upon  the  use  of 
opium,  in  some  form,  combined  with  the  local  appli- 
cation, on  lint,  of  the  following : 

5&.    Zinci  oxidi        .... 

Ol.  juniperi        .        .         .         .       aa  3  i. 
Adipis §i. 

M.    Ft.  ung. 

Frequently,  also,  a  neutral  salt  of  potassium  is 
given  as  a  diuretic. 


264  ECZEMA. 

DR.  R.  W.  TAYLOR  finds  soothing  applications, 
in  the  form  of  powders  or  lotions,  such  as  lead  and 
opium,  most  serviceable  in  the  erythematous  stage. 
As  the  disease  increases  in  age,  he  resorts  to  stimu- 
lation in  addition.  This  latter  measure  he  believes 
to  be  one  of  the  cardinal  points  in  the  treatment  of 
eczema ;  at  the  same  time  keeping  the  surface  well 
protected,  while  gradually  continuing  with  the  use  of 
the  stimulant  application.  Zinc  ointment  alone,  he 
advises,  will  not  effect  a  cure  unless  something  directly 
curative  is  added  ;  for  this  purpose  he  finds  tar  very 
serviceable.  He  also  believes  that,  in  most  cases, 
strong  solutions  of  potash  can  be  employed  with 
advantage,  and  will  afford  relief  where  soaps  often 
fail.  In  using  them,  however,  he  cautions  that  their 
action  must  be  controlled  so  as  to  get  the  effect  of 
strong  stimulation,  and  at  the  same  time  prevent 
any  inflammation. 

For  internal  medication,  in  his  experience  arsenic 
very  greatly  assists  the  external  treatment,  through 
its  power  to  stimulate  the  skin.  Therefore,  while 
he  considers  the  golden  rule  to  be  to  attend  to  the 
local  measures,  yet,  in  many  cases,  he  finds  the 
internal  use  of  arsenic  exceedingly  beneficial. 

The  following  is  constantly  used  at  the  NEW  YORK 
HOSPITAL  : 

I-L    Ung.  picis 3iv. 


HERPES.  265 

Zinci  oxidi 3i. 

Cerat.  simplic §  iss. 

M.    Ft.  unguent. 

Also  the  following,  as  an  eczema  drying  salve : 

9..  Plumbi  glycerat Si- 
ting, zinci  oxidi  .  .  .  §  i. 

M. 


HERPES. 


DR.  G.  H.  Fox  directs  attention  to  the  general 
health,  etc.,  administering  tonics,  iron,  strychnia,  and 
quinine,  according  to  the  indications  present.  Many 
cases  of  a  mild  character,  as  in  herpes  faciae  and 
labialis  following  a  common  cold,  where  the  eruption 
is  slight,  he  finds  require  little  or  nothing  more  in 
the  way  of  treatment.  The  syrupi  ferri  iodidi  is 
often  prescribed  very  effectually.  As  a  rule,  how- 
ever, for  local  measures  he  aims  to  protect  the  delicate 
walls  of  the  vesicles  from  rupture,  by  means  of  some 
dusting  powder,  such  as  pulv.  amyli,  lycopodium, 
or,  what  he  frequently  considers  better,  an  ointment 
of  zinc  oxide  and  lycopodium,  applied  liberally  and 
then  covered  with  a  bandage  to  prevent  rubbing  of 


266  HERPES. 

the  clothing.  If  the  vesicles  have  burst,  leaving  a 
raw  surface,  he  finds  powders  still  useful,  or  some- 
times a  simple  ointment  is  employed.  Frequently 
he  uses  unguent,  zinci  oxidi,  or  some  anodyne  lotion 
containing  opium,  belladonna,  and  camphor ;  or  in 
certain  cases  the  following  acts  veiy  beneficially : 

Tfr.    Acidi  carbolici       .         .         .     gr.  xii-xv. 
Aquae  ....  §i. 

M. 

He  also  prescribes  the  following  with  excellent 
service ; 

IjJ,.    Morphiae       .         .         .         .         .  gr.  x. 
Collodii  flexile       .         .         .  5  i« 

M.    Sig.     To  be  painted  over  the  part. 

In  zoster,  if  the  child  suffers  much  pain,  and 
especially  if  the  rest  is  much  disturbed  by  it,  DR. 
Fox  administers  opium  to  relieve  it.  For  the  neu- 
ralgic pains,  more  particularly  those  remaining  after 
the  local  lesion  has  healed,  he  considers  Fowler  s 
solution  in  doses  of  gtt.  v.  one  of  the  best  internal 
remedies.  Where  there  is  much  mental  worry,  a 
sleeping  draught  containing  potassium  bromide  and 
opium  is  generally  administered. 

In  zoster  occurring  in  older  children,  if  the  pains 
are  beyond  endurance,  DR.  W.  H.  DRAPER  gives 
morphia  to  control  them  ;  combined,  in  some  cases, 
with  counter-irritation.  Quinine  is  also  found  ser- 


ERYSIPELAS.  267 

viceable  in  many  instances.  Or,  belladonna  locally 
applied,  especially  in  combination  with  opium,  he 
finds  often  affords  relief.  Where  the  pains  continue, 
however,  in  spite  of  other  means  of  treatment,  the 
application  of  the  thermo  cautery  along  the  spinal 
column  is  sometimes  resorted  to  effectually.  (This 
latter  on  the  theory  that  the  disease  depends  upon 
congestion  or  inflammation  of  the  roots  of  the 
spinal  nerves.) 


ERYSIPELAS. 


DR.  A.  JACOBI  sometimes  employs  the  following 
treatment  very  satisfactorily : 

1^,.    Acid,  carbol gr.  xii. 

Acid,  oleic 3  ii. 

M. 

This  is  applied  to  the  skin  which  is  tolerably 
normal  around  the  erysipelatous  patch,  being 
thoroughly  rubbed  in  with  the  finger.  Only  a  small 
quantity  is  used  at  a  time,  and  the  application 
repeated  at  frequent  intervals  of  half  an  hour  or  an 
hour. 


268  ERYSIPELAS. 

DR.  V.  P.  GlBNEY  highly  recommends  the  follow- 
ing, in  cases  of  recurring  naso-facial  erysipelas  of  stru- 
mous  origin,  frequently  met  with  in  these  children : 

I£.    Tinct.  ferri  chlor.     .         .         .        3  ii-iii. 
Glycerinae        ....  %  iss. 

Aquae       .  §  iss- 

M.    Sig.  A  teaspoonful  every  two  hours. 

At  BELLEVUE  HOSPITAL  the  use  of  the  compound 
tincture  of  benzoin  in  the  treatment  of  this  disease,  is 
employed  with  good  results.  The  affected  parts  are 
painted  with  the  tincture  once  or  twice  daily.  As 
an  application  to  the  face,  sheet  lint  is  recommended, 
dipped  in  hot  lead  and  opium  solution.  Instead  of 
poultices,  in  erysipelas  of  the  extremities,  oakum  is 
used  soaked  in  hot  plumb,  et  opii  and  covered  well 
with  oil-silk.  By  this  means  the  moisture  of  the 
limb  is  retained,  and  a  soothing  influence  exerted 
over  the  part. 

At  the  PRESBYTERIAN  HOSPITAL  the  following 
method  of  treatment  has  been  administered  very 
successfully,  in  cases  of  erysipelas  in  older  children. 
Tinct.  ferri  cJiloridi  is  given  internally  in  large  doses 
and  repeated  every  hour  for  six  hours,  in  conjunc- 
tion with  quinine  in  full  doses  three  times  daily. 
Locally  the  application  of  liq.  plumbi  et  opii  is  em- 
ployed. In  many  instances  this  plan  is  attended 
with  favorable  results.  Where,  however,  there  is 


ERYTHEMA.  269 

rapid  extension  of  the  redness,  injections  of  carbolic 
acid  are  often  practiced,  as  follows  : 

$.    Acidi  carbolic!        .         .       ..         m.  xxx. 
Alcohol          .         .         .         .  3  ss. 

Aquae  destill.          ...  §  i. 

M. 

This  is  injected  at  the  upper  border  of  the  redness 
and  repeated  as  indicated.  After  the  extension  is 
under  control  and  improving,  these  are  discontinued 
and  local  applications  of  carbolic  acid  resorted  to. 
The  iron  and  quinine  are  also  continued.  By  this 
plan  of  treatment  success  has  followed,  when  other 
means  have  proven  altogether  useless. 


ERYTHEMA. 


In  cases  of  erythema  multiforme,  DR.  L.  D. 
BULKLEY  finds  the  following  mixture  very  potent  in 
reducing  the  cutaneous  congestion  in  this  condition, 
and  considers  it  a  remarkably  valuable  combination  : 

];&.    Magnes.  sulph §  i. 

Ferri  sulph.              .         .         .         .       3  i- 
Acid,  sulph.  dil 3  "• 


2/0  URTICARIA. 

Tinct.  gentian §  *• 

Aquae  §  iii. 

M.  Sig.  A  teaspoonful  to  a  tablespoonful  accord- 
ing to  age. 

In  erythema  nodosum,  DR.  G.  H.  Fox  often  de- 
rives much  benefit  from  placing  the  child  on  the  in- 
ternal use  of  syrupi  ferri  iodidi  gtt.  v.  three  times 
daily,  in  conjunction  with  the  local  application  of 
unguent,  zinci  oxidi.  When  indicated,  tonics  are 
also  administered  with  good  effect.  The  condition 
of  the  stomach  and  intestinal  canal  should  also  re- 
ceive careful  attention,  and  any  existing  disorder 
corrected. 


URTICARIA. 


DR.  L.  D.  BULKLEY  administers  alkaline  baths  at 
frequent  intervals,  combined  with  the  subsequent  in- 
unction of  carbolated  cosmoline,  as  follows : 

IJ.    Acid,  carbol gr.  v. 

Cosmolinae  .         .         .         .  §  i. 

M.    Ft.  ung. 

With  these  measures,  for  internal  medication,  he 


URTICARIA.  2/1 

also  prescribes  the  syrup  of  the  hypophosphites  of 
soda,  lime,  and  iron. 

In  chronic  cases  occurring  in  older  children,  where 
the  general  health  is  poor,  DR.  G.  H.  Fox  first 
places  the  child  on  the  following : 

$.     Potassii  acetat.  gr.  x. 

Aquae       .  q.  s. 

M.  Sig.  Dose,  three  times  daily,  to  a  child  of  ten 
to  twelve  years. 

This  is  continued  for  about  a  week,  after  which  he 
stops  this  drug  and  gives  tinct.  ferri  chlor.  gtt.  x. 
three  times  daily.  After  continuing  the  iron  for  a 
few  days,  he  then  orders  the  following : 

~fy.  Sol.  Fowlerii  ....  gtt.  v. 
Tinct.  ferri  chlor.  .  .  .  gtt.  x. 
Aquae q.  s. 

M.    Sig.  Dose,  thrice  daily,  after  meals. 

In  addition,  a  pill  containing^.  ^  of  aloin  is  taken 
every  morning  and  afternoon.  He  also  directs  the 
patient  to  remain  out  in  the  sun  as  much  as  possible, 
for  a  week  or  more.  Under  this  treatment  decided 
benefit  follows.  After  a  while,  as  improvement  oc- 
curs, he  changes  the  tincture  of  the  chloride  for  the 
ferri  ct  potass,  tart,  with  good  effect. 

DR.  A.  A.  SMITH  recommends  sodii  salicylat.  gr. 
ii.  every  half-hour  or  hour,  with  much  satisfaction  in 
the  treatment  of  urticaria. 


2/2  SCABIES. 

SCABIES. 
(ITCH.) 


DR.  W.  H.  DRAPER  usually  employs  sulphur, 
either  by  the  bath,  fumigation,  or,  as  a  rule,  in  the 
form  of  an  ointment.  By  this  latter  method,  also, 
he  finds  that  any  eruption  of  acne,  which  sometimes 
appears  when  the  sulphur  bath  is  used,  is  avoided. 
He  considers  it  very  important,  however,  that  the 
epidermis  should  first  be  softened,  in  order  to  render 
the  application  of  the  ointment  successful.  This  is 
accomplished  by  means  of  the  hot  bath,  the  skin 
being  well  rubbed  and  dried,  and  an  ointment  then 
applied  as  follows : 

IJ.    Sulphuris  ....          ^  iii. 

Potass,  carb §i. 

Adipis §viii. 

M. 

The  patient  is  afterward  clothed  in  flannel  and 
put  to  bed.  It  is  also  important,  he  advises,  that 
the  application  of  the  ointment  be  made  over  the 
entire  body,  not  simply  to  the  hands,  etc.,  otherwise 
the  parasite  migrates  to  other  parts.  The  only  por- 
tions of  the  body  which  can  be  spared  are  the  face 
and  neck,  as  these  are  rarely  attacked.  Sometimes  a 


SCABIES.  273 

single  application  is  sufficient,  but  he  generally  con- 
siders it  a  safer  plan  to  repeat  the  process  three  or 
four  times,  when  he  finds  this  treatment  usually 
attended  with  success.  In  some  rare  instances,  how- 
ever, the  disease  fails  to  yield  to  the  sulphur  treat- 
ment. Where  such  is  the  case,  this  remedy  is 
stopped,  and  a  carbolic  acid  ointment  applied,  thus : 
Tfr.  Acid,  carbol.  cryst.  ...  §i. 

Cosmolinae         ....         §xx. 
Sig.    Melt  each  separately  and  mix. 
This  measure  is  often  followed  by  a  speedy  sub- 
sidence of  the  disease. 

DR.  G.  H.  Fox  finds  the  following  of  most  excel- 
lent service  in  this  affection : 
Ijfc.     Sulphur,  praecip. 

Balsam,  peruv  .... 
Potass,  iodidi     .        .         .        .       Sa  3i. 
Cosmolinae        .         ...        .         3  vii. 
M.    Ft.  ung. 

Or,  in  some  instances,  he  uses  the  following  with 
good  effect : 

9,.    Sulphur,  loti          .... 

Sapon.  virid.          .        .        .         .   aa  |  i. 
M. 

DR.  L.  D.  BULKLEY  considers  sulphur  almost  a 
specific  in  this  affection.     He  directs  that  the  child 
be  first  washed  thoroughly  with  yellow  soap,  and 
18 


2/4  PHTHIRIASIS. 

then  have  the  following  ointment  applied  constantly 
for  two  or  three  days  and  nights : 

9,.    Sulphuris 3  L 

Styracis 3  fi- 
ling, adipis          .         .         .        .          %i. 
M. 

By   this    means,  he  has  frequently  succeeded  in 
curing  the  disease  in  a  very  short  time. 

The  following   sulphur  paste   is   extensively  em- 
ployed at  BELLEVUE  HOSPITAL  : 

Ijfc.    Sulphur,  sublimat.       .        .        .  §i. 

Athens 3  iii- 

Glycerinae §i. 

M. 


PHTHIRIASIS. 

(LOUSINESS.) 


DR.  G.  H.  Fox  places  the  greatest  reliance  upon 
local  treatment.  In  the  milder  cases  of  phthiriasis 
capitis,  he  finds  that  a  small  quantity  of  white  precip- 
itate ointment  of  full  strength,  rubbed,  not  in  the 
scalp,  but  throughout  the  hair,  will  effect  a  cure  in  a 


PHTHIRIASIS.  275 

few  days.     When  a  more  desirable  preparation  is 
required,  he  uses  the  following: 

]jfc.    Hydrarg.  corros.  chlor.     .        .          gr.  iv. 
Aquae  rosse       .        .         .        .  %i. 

M. 

Or  this  may  be  made  up  with  cologne  water,  or 
with  alcohol,  instead  of  rose  water.  Where,  however, 
much  laceration  of  the  scalp  is  present,  or  any  spots 
of  eczema,  the  mercurial  solution  is,  as  a  rule,  unsafe. 
Another  and  very  elegant  prescription,  which  is 
highly  favored  by  him  in  this  affection,  is  the  follow- 
ing: 

]pfc.    Hydrarg.  corros.  chlor.     .         .         gr.  iv. 
Thymol  .        .        .         .      gr.  xvi. 

Alcohol 5  i. 

Ol.  amygdal.  amar.  .         .        gtt.  v. 

M. 

The  oil  of  bitter  almond  added  to  the  solution,  he 
finds,  gives  it  a  more  pleasant  fragrance,  which  is 
sometimes  commendable. 

In  chronic  cases  of  long  standing,  he  thinks  there 
is  scarcely  any  better  and  simpler  plan  of  treatment, 
both  for  the  destruction  of  the  pediculi  and  the  soft- 
ening and  removal  of  the  ovi  from  the  hairs,  than 
the  application  of  kerosene  oil,  freely  used.  In  em- 
ploying this  remedy,  he  directs  that  the  head  be 
thoroughly  rubbed  with  the  oil,  and  at  night  covered 


2/6  TINJEA   FAVOSA. 

with  an  oil-skin  cap.  In  the  morning  the  parts  should 
be  well  washed  with  soap  and  water.  In  many  of 
these  neglected  cases,  he  often  finds  severe  forms  of 
eczema  capitis  present,  due  to  the  irritation  caused 
by  these  parasites.  For  this  an  ointment  of  zinc 
oxide  is  also  applied,  together  with  careful  attention 
to  diet,  etc. 

In  regard  to  the  necessity  of  cutting  off  the  hair, 
when  long,  Dr.  Fox  does  not  consider  it  absolutely 
essential,  provided  pains  are  taken  to  keep  it  clean 
and  well  dressed.  Where,  however,  the  hair  is 
allowed  to  become  matted  through  filth  and  neglect, 
he  believes  that  the  shears  play  an  important  part  in 
the  treatment.  This  latter,  he  advises,  applies  not 
only  to  this,  but  also  to  other  affections  of  the 

scalp. 


TINEA    FAVOSA. 

(FAVUS.) 


DR.  L.  D.  BULKLEY  considers  depilation  quite 
essential  in  the  treatment  of  this  disease,  a  view  not 
held  by  all. 


TINEA   FAVOSA. 

For  this  purpose  the  following  method  is  a  favorite 
with  him  : 

]£.    Cerae  flavae         ....         3  iii. 
Laccae  intabulis         .         .         .         3  iv. 

Resinae 3  vi. 

Picis  Burgundicae     .         .         .  3  x. 

Gummi  dammar.        .         .        .         3xii. 
M. 

This  is  made  into  sticks  of  various  sizes.  In  using 
it,  the  end  is  heated  until  soft  and  then  applied  to 
the  diseased  scalp,  the  hair  having  been  cut  short. 
As  soon  as  the  wax  becomes  cool  it  is  carefully 
withdrawn,  bringing  away  the  diseased  hairs.  He  then 
uses  the  following  wash  with  advantage  : 

$.    Hydrarg.  bichloridi  .         .         .        gr.  iv. 

Aquae §  i. 

M. 

Regarding  this  measure,  depilation,  he  directs  at- 
tention to  the  fact,  that  many  chronic  cases  are  due 
to  the  error  of  supposing  the  disease  is  in  a  fair  way  to 
recovery,  when  there  are  no  longer  any  crusts  to  be 
seen.  He  therefore  advises  that  it  is  unsafe  to  dis- 
miss a  patient,  until  every  hair  that  has  been,  or  is 
liable  to  be,  affected  has  been  epilated. 


2/8  TINEA   TONSURANS. 


TINEA  TONSURANS. 
(RINGWORM.) 


DR.  G.  H.  Fox  highly  recommends  the  following, 
as  of  the  greatest  efficacy  in  many  of  these  cases : 
]pL     Acid,  carbol.         .         .         .        gr.  xlviii. 

Glycerinae 3  ii. 

Alcohol 

Ol.  cadini      ....          aa  3  iii. 
Ol.  citronellse        .         .         .  q.  s. 

M. 

Chrysophanic  acid  is  considered  most  efficacious 
by  many  ;  or,  in  exceptional  cases,  combined  with  car- 
bolic acid.  In  young  children,  however,  it  must  be 
used  with  caution,  if  at  all.  The  following  is  the 
formula  used  at  BELLEVUE  HOSPITAL: 

]jL    Acidi  chrysophanici     .         .         .     gr.  xx. 
Oleo-paraffini      ...       3  iii-  gr.  x. 
Sig.  Melt  the  vaseline,  and  while  hot  add  the 
acid,  stirring  till  dissolved. 

Or,  tincture  of  iodine,  painted  on  once  or  twice 
daily  and  followed  by  the  use  of  white  precipitate 
ointment,  is  often  found  to  be  sufficient.  Tonics  are 
also  valuable  in  many  cases,  especially  cod  liver  oil, 


ALOPECIA   AREATA.  2/9 

together  with  iron,  etc.  Sometimes  the  unguentum 
picis  liquidum  is  of  excellent  service.  This  is  com- 
bined at  Bellevue  Hospital,  as  follows: 

$.     Picis  liquidae         .         .         .        .         3i« 

Potassae 3ss. 

Aquae  fervent,  q.  s.  ad        .        .          §  *• 
M.     Et  add. 

Cerati viii. 


ALOPECIA  AREATA. 
(TINEA  DECALVANS.) 


In  many  instances  DR.  G.  H.  Fox  finds  the  fol- 
lowing plan  of  treatment  very  successful.  Reorders 
a  five  per  cent,  oleate  of  mercury  to  be  rubbed  into  the 
scalp  night  and  morning.  Small  doses  of  calomel 
are  also  given  internally,  as  a  laxative.  After  con- 
tinuing this  for  two  or  three  weeks,  should  no  ma- 
terial benefit  be  derived,  he  substitutes  liquor  am- 
mon.  fort,  for  the  oleate,  as  an  application  to  the 
scalp,  and,  if  indicated,  administers  cod  liver  oil  with 
good  effect.  Or,  in  certain  cases,  where  a  stimula- 
ting wash  is  desired,  the  following  is  recommended  by 
him : 


280  ALOPECIA  AREATA. 

9.     Tinct.  capsici        ....      §iii. 
Tinct.  cantharidis  .        .  §  ii. 

Aquae  rosae     •         .        .         .  j§v. 

M.    Ft.  lotio. 

In  others,  where  the  general  health  is  poor,  he  fre- 
quently prescribes : 

^.    Tinct.  ferri  chloridi          .        .        gtt.  x. 
Sol.    Fowlerii  ....         gtt.  v. 
M.    Sig.   Dose,  three  times  daily,  to  a  child  of 
eight  to  ten  years. 

This  is  continued  for  a  week  or  so,  according  to 
indications.  He  then  often  finds  the  following  very 
satisfactory : 

$.    Sapon.  viridis       .         .         .         .          31. 

Spts.  vini  rect §i. 

M.    Sig.  Use  as  a  wash. 

Also,  in  numerous  instances,  he  gives  small  doses 
of  ext.  jaborandi  fl.  with  great  advantage.  As  im- 
provement takes  place,  this  is  then  continued  in 
diminished  doses  for  a  short  time  afterward,  with 
benefit.  Or,  sometimes  he  uses  pyrogallic  acid  with 
very  gratifying  effect ;  thus  : 

Ijjfc-    Acidi  pyrogall 3  iii- 

Glycerinae  .         .          3  i- 

Aquae §  ii. 

M.    Ft.  lotio. 


PSORIASIS.  28l 


PSORIASIS. 


In  .many  of  these  cases,  DR.  G.  H.  Fox  first  directs 
his  treatment  to  the  general  health  of  the  patient. 
If  there  is  any  stomach  and  intestinal  disorder 
present,  this  is  corrected  by  the  administration  of 
bismuth  subnitrate  and  rhei  et  sodce.  After  a  better 
condition  is  attained  in  this  direction,  where  the  child 
is  anaemic  and  with  poor  appetite,  he  then  finds  that 
a  marked  degree  of  improvement  takes  place  under 
the  administration  of  iron  and  cod  liver  oil.  He 
gives  : 

~fy.    Syrupi  ferri  iodidi       .         .         .          3  iv. 
Olei  morrhuae  ....          5  Hiss. 

M.  Sig.  A  teaspoonful  three  times  daily,  to  a 
child  of  six  to  ten  years. 

In  conjunction  with  this  he  often  derives  benefit 
from  the  application  of  unguent,  hydrarg.  ammoniat. 
Or,  where  the  lesions  are  very  extensive  he  some- 
times applies  acid,  chrysophanic.  pur.  covered  with 
collodion,  on  certain  portions,  and  on  the  rest  ol. 
cajeput.  This  is  continued  as  necessary,  and  is 
generally  attended  with  success.  Combined  with  this 
treatment,  the  internal  use  of  arsenic  is  frequently 
prescribed  by  him  with  much  service  ;  thus : 


282  PITYRIASIS. 

9-    Liq.  potass,  arsenit.     .         .        .         3  ii. 
Aquae  cinnam.  ...          §  iiss. 

M.    Sig.  Half  a  teaspoonful  three  times  daily. 

Or,  at  times,  the  following  is  preferred : 

9.    Sol.  Fowlerii        .         .         .         .         3  ii. 
Tinct.    cinchonas   co.  3  iii. 

M.    Sig.  A  teaspoonful  thrice  daily,  to  a  child  of 
eight  to  ten  years. 

By   these   means   of    treatment    the   results    are 
usually  very  favorable. 


PITYRIASIS. 


In  pityriasis  capitis,  DR.  G.  H.  Fox  sometimes 
directs  that  the  patient  be  given  a  hot  bath  every 
night,  and  during  this  procedure  to  use  as  a  shampoo 
to  the  head  and  body  equal  parts  of  sapo  viride  and 
alcohol  ;  and  upon  leaving  the  bath,  to  rub  vaseline 
into  the  affected  parts.  In  certain  cases,  where  an 
elegant  application  is  desired,  the  following  is  highly 
recommended  by  him : 

9.    Chloralis 3iv. 

Glycerinae 3  i« 


PURPURA  H^EMORRHAGICA.  283 

Spiritus  myrciae          .         .        .  3  x. 

Aquae          .         ....  §v. 
M.    Ft.  lotio. 

In  pityriasis  versicolor,  he  finds  the  following  very 
effectual : 

$.    Sulphuris 3  ii. 

Sapon.  viridis     .         .         .         .  3  iii- 

Glycerinae          .          ...  3ss. 
M.    Ft.  ung. 


PURPURA  H^EMORRHAGICA. 

(MORBUS  MACULOSUS.) 


DR.  A.  JACOBI  directs  attention  to  this  condition 
occurring  in  childhood,  as  generally  arising  from  a 
defective  development,  from  an  abnormal  state  of 
the  bloodvessels ;  often  associated  with  a  large 
fatty  liver,  with  a  luxuriant  growth  of  the  adipose 
tissue  of  the  body,  and  not  infrequently  with  fatty 
degeneration  of  the  heart.  One  of  the  chief  ele> 
ments  of  his  treatment  is  to  prevent  relapses  of  the 
hemorrhages,  by  careful  attention  to  dietetic  and 
hygienic  regulations.  He  advises  that  the  patient 


284  PURPURA   H^MORRHAGICA. 

should  have  three  or  four  hours  leisure  daily,  com- 
bined with  exercise  out  of  doors,  e.  g.  The  child 
should  be  out  in  the  open  air  for  two  or  three  hours, 
walk  about  three  miles  a  day,  and  have  a  cold  bath, 
or  cold  sponging,  every  morning.  Regarding  diet, 
he  directs  that  all  fatty  and  fat  producing  foods, 
such  as  fat  itself,  sugars,  starches,  etc.,  be  rigidly 
avoided,  and  the  patient  fed  with  meat  and  milk  in 
abundance,  and  with  but  a  moderate  amount  of 
vegetable  diet.  As  for  medication,  he  derives  much 
benefit  from  placing  the  child  on  the  syrup  of  the 
iodide  of  iron.  In  some  cases,  the  tendency  to 
hemorrhage  may  be  lessened  by  the  administration 
of  ergot ;  but  where  there  has  been  no  tendency  to 
dangerous  hemorrhages,  he  does  not  consider  this 
necessary.  He  also  administers  dilute  sulphuric  acid 
as  a  direct  tonic  to  the  blood  vessels  ;  cautioning, 
however,  against  a  too  long  continuance  of  its  use, 
as  after  a  time  it  tends  to  disintegrate  the  red  blood 
corpuscles.  Of  this,  he  usually  gives  3ss.  in  the 
course  of  twenty-four  hours,  to  a  child  of  ten  to 
fourteen  years.  In  addition  to  these  measures,  in 
many  instances,  he  also  prescribes  quinicB  sulpJiat.  in 
' 'doses  of  gr.  ii-iii.  three  times  daily,  with  excellent 
effect. 


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TREATMENT  OF  DISEASES  OF  THE 

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DATE  DUE 


PRINTED  IN  U.S.A. 


000  432  608 


WS366" 


•i  DOo 

Goodwin,  Charles  H. 

Treatment  of  diseases  of 
infancy  and  childhood,. 


ITS  366 
G65  6t 

1883 
Goodvin  Charles  H. 

Treatment  of  diseases  of  infancy  and 
childhood,  .  .  . 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


